Inhibidores del cotransportador sodio-glucosa tipo 2 para la prevención de eventos cardiovasculares en adultos con diabetes tipo 2: una revisión sistemática
DOI:
https://doi.org/10.66201/ss.v1.10Palabras clave:
inhibidores SGLT2, diabetes mellitus tipo 2, prevención cardiovascular primaria, eventos cardiovasculares mayores, función renal, cardioprotecciónResumen
Antecedentes: La diabetes mellitus tipo 2 (DM2) representa una pandemia global donde las complicaciones cardiovasculares (CV) son la principal causa de muerte. Aunque los inhibidores del cotransportador sodio-glucosa tipo 2 (iSGLT2) han demostrado beneficios cardiorrenales, la evidencia se centró inicialmente en la prevención secundaria. El objetivo de esta revisión integrativa fue sintetizar la eficacia de los iSGLT2 en la prevención primaria de eventos CV en adultos con DM2 sin enfermedad CV establecida.
Métodos: Se empleó una metodología de revisión integrativa, recuperando estudios publicados entre 2020 y 2025. Se incluyeron 56 estudios, predominantemente análisis post-hoc de ensayos clínicos, que involucraron a más de 125 000 participantes. La calidad metodológica fue evaluada rigurosamente con herramientas validadas.
Resultados: Los iSGLT2 demostraron un beneficio CV y renal robusto. Se observó una reducción estadísticamente significativa del 14 % en el riesgo de eventos cardiovasculares mayores (MACE), siendo el efecto más notable una disminución del 31 % en la hospitalización por insuficiencia cardíaca. Además, el tratamiento se asoció con nefroprotección, evidenciada por una reducción del 39 % en el desenlace renal compuesto y una preservación de la función renal. También se documentó una reducción del 15 % en la mortalidad por cualquier causa. Estos efectos fueron independientes del control glucémico basal y se atribuyen a mecanismos pleiotrópicos, como la reducción de la presión arterial, la pérdida de peso y la atenuación de la inflamación sistémica. El perfil de seguridad fue favorable, siendo la infección micótica genitourinaria el evento adverso más frecuente.
Conclusiones: Los iSGLT2 proporcionan beneficios cardiorrenales y de supervivencia tangibles en la prevención primaria de DM2. Es imperativo actualizar las guías clínicas y establecer políticas de salud pública, incluyendo la negociación de precios y la inclusión en listas de medicamentos esenciales, para abordar las disparidades y facilitar el acceso equitativo y universal a estas terapias.
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Derechos de autor 2026 Karina De Sousa Gomes, Potira Paz de Souza, Nayane Parente Lima Pieretti, Emerson Aragão Almeida, Rogério Bernardo, Walter Queiroz Maia Filho, Paola Fernanda Fedatto, Andrea Paola Britos Gómez
Esta obra está bajo una licencia internacional Creative Commons Atribución 4.0.
