Sodium-glucose co-transporter-2 inhibitors for the prevention of atrial fibrillation: a systemic review and meta-analysis.

Publisher: Oxford University Press Country of Publication: England NLM ID: 101564430 Publication Model: Print Cited Medium: Internet ISSN: 2047-4881 (Electronic) Linking ISSN: 20474873 NLM ISO Abbreviation: Eur J Prev Cardiol Subsets: MEDLINE

Publication: 2021- : [Oxford] : Oxford University Press
Original Publication: London : Sage

Sodium-Glucose Transporter 2 Inhibitors*/therapeutic use ; Atrial Fibrillation*/drug therapy ; Atrial Fibrillation*/prevention & control ; Atrial Fibrillation*/epidemiology ; Diabetes Mellitus, Type 2*/drug therapy; Humans ; Risk Assessment ; Randomized Controlled Trials as Topic ; Treatment Outcome ; Male

Aims: Sodium-glucose co-transporter-2 (SGLT2) inhibitors are reported to have cardiac benefits. The effects of SGLT2 inhibitors on the prevention of atrial fibrillation (AF) remain inconclusive. We aimed to investigate whether SGLT2 inhibitors can prevent AF occurrence in patients with cardiometabolic diseases.
Methods and Results: We searched MEDLINE, EMBASE, and the Cochrane CENTRAL database up to 1 July 2023. Randomized, placebo-controlled trials of SGLT2 inhibitors in patients with diabetes, heart failure, chronic kidney diseases (CKDs), or cardiometabolic risk factors were included. The primary outcome was AF occurrence. Relative risks (RRs) with 95% confidence intervals (CIs) were calculated in the overall population and selected subgroups. Forty-six trials comprising 101 100 patients were included. Overall, no significant risk reduction of AF occurrence was observed with SGLT2 inhibitors, although there was a favourable trend (RR 0.90, 95% CI 0.80-1.01). In trials with follow-up durations of over 1 year, a similar result was achieved (RR 0.90, 95% CI 0.80-1.01). The results were consistent across different SGLT2 inhibitors, with RRs (95% CIs) of 0.82 (0.60-1.12) for canagliflozin, 0.87 (0.73-1.03) for dapagliflozin, 0.97 (0.78-1.22) for empagliflozin, 0.99 (0.66-1.50) for sotagliflozin, and 0.87 (0.58-1.29) for ertugliflozin. Analyses in different doses of SGLT2 inhibitors yielded similar results. The associations between SGLT2 inhibitors and AF occurrence were also absent in patients with diabetes, heart failure, and CKDs.
Conclusion: For patients with cardiometabolic diseases or risk factors, SGLT2 inhibitors did not decrease the risk of AF occurrence, regardless of follow-up duration, type or dose of the drug, or the patient population.
Competing Interests: Conflict of interest: H.-D.Z., L.D., Y.-J.S., and M.T. take responsibility for the content of the manuscript, including the data and analysis.
(© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: [email protected].)

Comment in: Eur J Prev Cardiol. 2024 May 11;31(7):768-769. doi: 10.1093/eurjpc/zwad372. (PMID: 38057154)

U1913210 National Natural Science Foundation of China; 2022-I2M-C&T-B-047 CAMS Innovation Fund for Medical Sciences

Keywords: Atrial fibrillation; Diabetes; Heart failure; Meta-analysis; SGLT2 inhibitors
Local Abstract: [plain-language-summary] The effects of sodium–glucose co-transporter-2 (SGLT2) inhibitors on the prevention of atrial fibrillation (AF) remain inconclusive. For patients with cardiometabolic diseases or risk factors, SGLT2 inhibitors did not decrease the risk of AF occurrence, regardless of follow-up duration, type or dose of the drug, or the patient population.Further research is warranted to investigate the potential benefit of SGLT2 inhibitors in AF.

0 (Sodium-Glucose Transporter 2 Inhibitors)

Date Created: 20231115 Date Completed: 20240511 Latest Revision: 20240610

20240610

10.1093/eurjpc/zwad356

37966828