III．心不全の治療 3．慢性心不全薬物治療の新しいトピックス
本邦における慢性心不全の標準治療薬は，レニン・アンジオテンシン・アルドステロン系阻害薬やβ遮断薬，利尿薬等古典的な薬剤が中心である．次々に新規薬剤が上市される腫瘍領域とは対照的に，新規の慢性心不全治療薬はここ数年，登場していない．その背景には，心不全が多彩な病因・病態を基盤とした症候群であり，そのために，特異的な治療薬の開発が困難であったことが関連していると想定される．しかし近年，心不全の薬物療法には，いくつかの新たな動きがみられている．...
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| Published in | 日本内科学会雑誌 Vol. 109; no. 2; pp. 215 - 223 |
|---|---|
| Main Authors | , |
| Format | Journal Article |
| Language | Japanese |
| Published |
一般社団法人 日本内科学会
10.02.2020
|
| Subjects | |
| Online Access | Get full text |
| ISSN | 0021-5384 1883-2083 |
| DOI | 10.2169/naika.109.215 |
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| Abstract | 本邦における慢性心不全の標準治療薬は，レニン・アンジオテンシン・アルドステロン系阻害薬やβ遮断薬，利尿薬等古典的な薬剤が中心である．次々に新規薬剤が上市される腫瘍領域とは対照的に，新規の慢性心不全治療薬はここ数年，登場していない．その背景には，心不全が多彩な病因・病態を基盤とした症候群であり，そのために，特異的な治療薬の開発が困難であったことが関連していると想定される．しかし近年，心不全の薬物療法には，いくつかの新たな動きがみられている． |
|---|---|
| AbstractList | 本邦における慢性心不全の標準治療薬は，レニン・アンジオテンシン・アルドステロン系阻害薬やβ遮断薬，利尿薬等古典的な薬剤が中心である．次々に新規薬剤が上市される腫瘍領域とは対照的に，新規の慢性心不全治療薬はここ数年，登場していない．その背景には，心不全が多彩な病因・病態を基盤とした症候群であり，そのために，特異的な治療薬の開発が困難であったことが関連していると想定される．しかし近年，心不全の薬物療法には，いくつかの新たな動きがみられている． |
| Author | 田中, 敦史 野出, 孝一 |
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| References | 17) Perkovic V, et al: Canagliflozin and renal outcomes in type 2 diabetes and nephropathy. N Engl J Med 380: 2295-2306, 2019. 19) Fitchett DH, et al: Heart failure outcomes in clinical trials of glucose-lowering agents in patients with diabetes. Eur J Heart Fail 19: 43-53, 2017. 2) Swedberg K, et al: Ivabradine and outcomes in chronic heart failure (SHIFT): a randomised placebo-controlled study. Lancet 376: 875-885, 2010. 12) Zinman B, et al: Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes. N Engl J Med 373: 2117-2128, 2015. 21) Zheng SL, et al: Association between use of sodium-glucose cotransporter 2 inhibitors, glucagon-like peptide 1 agonists, and dipeptidyl peptidase 4 inhibitors with all-cause mortality in patients with type 2 diabetes: a systematic review and meta-analysis. JAMA 319: 1580-1591, 2018. 5) Ponikowski P, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J 37: 2129-2200, 2016. 9) Solomon SD, et al: The angiotensin receptor neprilysin inhibitor LCZ696 in heart failure with preserved ejection fraction: a phase 2 double-blind randomised controlled trial. Lancet 380: 1387-1395, 2012. 15) Zelniker TA, et al: SGLT2 inhibitors for primary and secondary prevention of cardiovascular and renal outcomes in type 2 diabetes: a systematic review and meta-analysis of cardiovascular outcome trials. Lancet 393: 31-39, 2019. 13) Neal B, et al: Canagliflozin and cardiovascular and renal events in type 2 diabetes. N Engl J Med 377: 644-657, 2017. 18) McMurray JJV, et al: Dapagliflozin in patients with heart failure and reduced ejection fraction. N Engl J Med 381: 1995-2008, 2019. 3) Swedberg K, et al: Effects on outcomes of heart rate reduction by ivabradine in patients with congestive heart failure: is there an influence of beta-blocker dose?: findings from the SHIFT (Systolic Heart failure treatment with the I (f) inhibitor ivabradine Trial) study. J Am Coll Cardiol 59: 1938-1945, 2012. 7) McMurray JJ, et al: Angiotensin-neprilysin inhibition versus enalapril in heart failure. N Engl J Med 371: 993-1004, 2014. 1) Fox K, et al: Ivabradine for patients with stable coronary artery disease and left-ventricular systolic dysfunction (BEAUTIFUL): a randomised, double-blind, placebo-controlled trial. Lancet 372: 807-816, 2008. 16) Kato ET, et al: Effect of dapagliflozin on heart failure and mortality in type 2 diabetes mellitus. Circulation 139: 2528-2536, 2019. 22) Davies MJ, et al: Management of hyperglycemia in type 2 diabetes, 2018. A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care 41: 2669-2701, 2018. 14) Wiviott SD, et al: Dapagliflozin and cardiovascular outcomes in type 2 diabetes. N Engl J Med 380: 347-357, 2019. 20) Zelniker TA, et al: Comparison of the effects of glucagon-like peptide receptor agonists and sodium-glucose cotransporter 2 inhibitors for prevention of major adverse cardiovascular and renal outcomes in type 2 diabetes mellitus. Circulation 139: 2022-2031, 2019. 11) Tsutsui H, et al: Efficacy and safety of sacubitril/valsartan (LCZ696) in Japanese patients with chronic heart failure and reduced ejection fraction: Rationale for and design of the randomized, double-blind PARALLEL-HF study. J Cardiol 70: 225-231, 2017. 4) Yancy CW, et al: 2016 ACC/AHA/HFSA focused update on new pharmacological therapy for heart failure: an update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. Circulation 134: e282-293, 2016. 10) Solomon SD, et al: Angiotensin-neprilysin inhibition in heart failure with preserved ejection fraction. N Engl J Med 381: 1609-1620, 2019. 8) Velazquez EJ, et al: Angiotensin-neprilysin inhibition in acute decompensated heart failure. N Engl J Med 380: 539-548, 2019. 6) Tsutsui H, et al: Efficacy and safety of ivabradine in Japanese patients with chronic heart failure - J-SHIFT Study. Circ J 83: 2049-2060, 2019. |
| References_xml | – reference: 6) Tsutsui H, et al: Efficacy and safety of ivabradine in Japanese patients with chronic heart failure - J-SHIFT Study. Circ J 83: 2049-2060, 2019. – reference: 7) McMurray JJ, et al: Angiotensin-neprilysin inhibition versus enalapril in heart failure. N Engl J Med 371: 993-1004, 2014. – reference: 17) Perkovic V, et al: Canagliflozin and renal outcomes in type 2 diabetes and nephropathy. N Engl J Med 380: 2295-2306, 2019. – reference: 22) Davies MJ, et al: Management of hyperglycemia in type 2 diabetes, 2018. A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care 41: 2669-2701, 2018. – reference: 1) Fox K, et al: Ivabradine for patients with stable coronary artery disease and left-ventricular systolic dysfunction (BEAUTIFUL): a randomised, double-blind, placebo-controlled trial. Lancet 372: 807-816, 2008. – reference: 12) Zinman B, et al: Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes. N Engl J Med 373: 2117-2128, 2015. – reference: 8) Velazquez EJ, et al: Angiotensin-neprilysin inhibition in acute decompensated heart failure. N Engl J Med 380: 539-548, 2019. – reference: 18) McMurray JJV, et al: Dapagliflozin in patients with heart failure and reduced ejection fraction. N Engl J Med 381: 1995-2008, 2019. – reference: 5) Ponikowski P, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J 37: 2129-2200, 2016. – reference: 2) Swedberg K, et al: Ivabradine and outcomes in chronic heart failure (SHIFT): a randomised placebo-controlled study. Lancet 376: 875-885, 2010. – reference: 16) Kato ET, et al: Effect of dapagliflozin on heart failure and mortality in type 2 diabetes mellitus. Circulation 139: 2528-2536, 2019. – reference: 20) Zelniker TA, et al: Comparison of the effects of glucagon-like peptide receptor agonists and sodium-glucose cotransporter 2 inhibitors for prevention of major adverse cardiovascular and renal outcomes in type 2 diabetes mellitus. Circulation 139: 2022-2031, 2019. – reference: 9) Solomon SD, et al: The angiotensin receptor neprilysin inhibitor LCZ696 in heart failure with preserved ejection fraction: a phase 2 double-blind randomised controlled trial. Lancet 380: 1387-1395, 2012. – reference: 15) Zelniker TA, et al: SGLT2 inhibitors for primary and secondary prevention of cardiovascular and renal outcomes in type 2 diabetes: a systematic review and meta-analysis of cardiovascular outcome trials. Lancet 393: 31-39, 2019. – reference: 21) Zheng SL, et al: Association between use of sodium-glucose cotransporter 2 inhibitors, glucagon-like peptide 1 agonists, and dipeptidyl peptidase 4 inhibitors with all-cause mortality in patients with type 2 diabetes: a systematic review and meta-analysis. JAMA 319: 1580-1591, 2018. – reference: 11) Tsutsui H, et al: Efficacy and safety of sacubitril/valsartan (LCZ696) in Japanese patients with chronic heart failure and reduced ejection fraction: Rationale for and design of the randomized, double-blind PARALLEL-HF study. J Cardiol 70: 225-231, 2017. – reference: 14) Wiviott SD, et al: Dapagliflozin and cardiovascular outcomes in type 2 diabetes. N Engl J Med 380: 347-357, 2019. – reference: 4) Yancy CW, et al: 2016 ACC/AHA/HFSA focused update on new pharmacological therapy for heart failure: an update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. Circulation 134: e282-293, 2016. – reference: 3) Swedberg K, et al: Effects on outcomes of heart rate reduction by ivabradine in patients with congestive heart failure: is there an influence of beta-blocker dose?: findings from the SHIFT (Systolic Heart failure treatment with the I (f) inhibitor ivabradine Trial) study. J Am Coll Cardiol 59: 1938-1945, 2012. – reference: 19) Fitchett DH, et al: Heart failure outcomes in clinical trials of glucose-lowering agents in patients with diabetes. Eur J Heart Fail 19: 43-53, 2017. – reference: 13) Neal B, et al: Canagliflozin and cardiovascular and renal events in type 2 diabetes. N Engl J Med 377: 644-657, 2017. – reference: 10) Solomon SD, et al: Angiotensin-neprilysin inhibition in heart failure with preserved ejection fraction. N Engl J Med 381: 1609-1620, 2019. |
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| Title | III．心不全の治療 3．慢性心不全薬物治療の新しいトピックス |
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