<International Circulation>: The observation that increased glucose indicates risk for heart failure is of potential clinical importance. Does glucose lowering have a direct benefit for the heart failure patient?

　 《国际循环》：观察发现血糖升高预示有心力衰竭风险，这一发现具有潜在的临床意义，那么降低血糖是否能使心力衰竭患者获益呢？

　　Professor Ray: For glucose lowering with respect to heart failure， if you look at the meta-analyses of data that we have， per se， doesn’t actually result in a significant reduction in hospitalizations for heart failure. That could be because it’s the regimens that we are using and it could be other unwanted side effects which negate any potential benefit. The benefits of glucose lowering by-and-large are weaker than other interventions but tend to be on coronary disease events， so non-fatal myocardial infarction and coronary disease death which is a composite of CHD. The effect， if any， on heart failure with current agents is likely to be weak because if you don’t see it in 33000 people that you have studied then the effect is probably not going to be clinically relevant at least with currently available drugs.

　　Ray教授:关于降低血糖对心力衰竭的影响，回顾我们现有数据的荟萃分析不难发现，降低血糖本身并不能降低心力衰竭患者的住院率。可能是因为这是我们目前正在应用的临床治疗策略，也可能是因为副作用抵消了应有的获益。总体来说，降低血糖所带来的获益不如其他干预措施，却有导致非致死性心肌梗死和冠心病死亡等冠脉事件增加的趋势。既然在之前的33 000例患者中都没有发现降低血糖有减少心力衰竭的作用，那么即使存在的话，这种作用也很微弱，至少目前已有的药物并不具有这种临床效果。