Association between sodium-glucose cotransporter-2 inhibitors and arrhythmic outcomes in patients with diabetes and pre-existing atrial fibrillation.

Publisher: Oxford University Press Country of Publication: England NLM ID: 100883649 Publication Model: Print Cited Medium: Internet ISSN: 1532-2092 (Electronic) Linking ISSN: 10995129 NLM ISO Abbreviation: Europace Subsets: MEDLINE

Publication: 2006- : Oxford : Oxford University Press
Original Publication: London ; Philadelphia : Saunders, c1999-

Diabetes Mellitus, Type 2*/complications ; Diabetes Mellitus, Type 2*/diagnosis ; Diabetes Mellitus, Type 2*/drug therapy ; Atrial Fibrillation*/diagnosis ; Atrial Fibrillation*/drug therapy ; Atrial Fibrillation*/epidemiology ; Sodium-Glucose Transporter 2 Inhibitors*/adverse effects ; Ischemic Attack, Transient* ; Brain Ischemia* ; Stroke*/epidemiology ; Stroke*/prevention & control ; Dipeptidyl-Peptidase IV Inhibitors*/therapeutic use ; Dipeptidyl-Peptidase IV Inhibitors*/pharmacology ; Heart Failure*/epidemiology ; Ischemic Stroke*; Adult ; Humans ; Cohort Studies ; Glucose ; Sodium ; Hypoglycemic Agents ; Retrospective Studies

Aims: Prior studies suggest that sodium-glucose cotransporter-2 inhibitors (SGLT2is) may decrease the incidence of atrial fibrillation (AF). However, it is unknown whether SGLT2i can attenuate the disease course of AF among patients with pre-existing AF and Type II diabetes mellitus (DM). In this study, our objective was to examine the association between SGLT2i prescription and arrhythmic outcomes among patients with DM and pre-existing AF.
Methods and Results: We conducted a population-based cohort study of adults with DM and AF between 2014 and 2019. Using a prevalent new-user design, individuals prescribed SGLT2i were matched 1:1 to those prescribed dipeptidyl peptidase-4 inhibitors (DPP4is) based on time-conditional propensity scores. The primary endpoint was a composite of AF-related healthcare utilization (i.e. hospitalization, emergency department visits, electrical cardioversion, or catheter ablation). Secondary outcome measures included all-cause mortality, heart failure (HF) hospitalization, and ischaemic stroke or transient ischaemic attack (TIA). Cox proportional hazard models were used to examine the association of SGLT2i with the study endpoint. Among 2242 patients with DM and AF followed for an average of 3.0 years, the primary endpoint occurred in 8.7% (n = 97) of patients in the SGLT2i group vs. 10.0% (n = 112) of patients in the DPP4i group [adjusted hazard ratio 0.73 (95% confidence interval 0.55-0.96; P = 0.03)]. Sodium-glucose cotransporter-2 inhibitors were associated with significant reductions in all-cause mortality and HF hospitalization, but there was no difference in the risk of ischaemic stroke/TIA.
Conclusion: Among patients with DM and pre-existing AF, SGLT2is are associated with decreased AF-related health resource utilization and improved arrhythmic outcomes compared with DPP4is.
Competing Interests: Conflict of interest: D.L. has received in-kind support from Abbott Laboratories for a trial of continuous glucose monitors. S.B.W. has received grant funding from Servier Inc., unrelated to this work. D.S.C. reports grant funding from the Canadian Institutes of Health Research and the Heart and Stroke Foundation of Canada. The remaining authors report no relevant disclosures.
(© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.)

J Am Heart Assoc. 2015 Aug 27;4(9):e002183. (PMID: 26316524)
Curr Epidemiol Rep. 2018 Sep;5(3):272-283. (PMID: 30666285)
J Am Coll Cardiol. 2018 Jun 12;71(23):2628-2639. (PMID: 29540325)
Eur Heart J. 2018 Feb 7;39(6):442-449. (PMID: 29020388)
BMC Nephrol. 2009 Oct 19;10:30. (PMID: 19840369)
Diabetologia. 2018 Mar;61(3):722-726. (PMID: 29197997)
Circ Cardiovasc Imaging. 2023 Apr;16(4):e015176. (PMID: 37071716)
BMJ. 2020 Sep 23;370:m3342. (PMID: 32967856)
ESC Heart Fail. 2020 Dec;7(6):4429-4437. (PMID: 32946200)
Can J Cardiol. 2020 Apr;36(4):543-553. (PMID: 31837891)
Pharmacoepidemiol Drug Saf. 2017 Apr;26(4):459-468. (PMID: 27610604)
World J Cardiol. 2021 Oct 26;13(10):585-592. (PMID: 34754403)
Front Cardiovasc Med. 2022 Oct 20;9:1011429. (PMID: 36337862)
Ann Intern Med. 2020 Sep 15;173(6):417-425. (PMID: 32716707)
N Engl J Med. 2015 Jul 16;373(3):232-42. (PMID: 26052984)
Cardiovasc Diabetol. 2022 Jun 28;21(1):118. (PMID: 35765074)
J Am Heart Assoc. 2021 Sep 7;10(17):e022222. (PMID: 34459238)
Trends Cardiovasc Med. 2017 Apr;27(3):194-202. (PMID: 28291655)
Hypertension. 2009 Dec;54(6):1423-8. (PMID: 19858407)
JACC Clin Electrophysiol. 2022 Nov;8(11):1393-1404. (PMID: 36424008)
Circulation. 2022 Oct 18;146(16):1259-1261. (PMID: 36251785)
BMJ Open Diabetes Res Care. 2020 Jun;8(1):. (PMID: 32565422)
Int J Mol Sci. 2021 Jul 26;22(15):. (PMID: 34360742)
Int J Epidemiol. 2015 Feb;44(1):324-33. (PMID: 25501468)
JAMA Intern Med. 2023 Mar 1;183(3):242-254. (PMID: 36745425)
Stat Med. 2017 Nov 30;36(27):4391-4400. (PMID: 28913837)
Front Physiol. 2018 Nov 21;9:1575. (PMID: 30519189)
JAMA Cardiol. 2021 Feb 1;6(2):148-158. (PMID: 33031522)
PLoS One. 2023 Jan 18;18(1):e0280359. (PMID: 36652465)
Heart Rhythm O2. 2021 Nov 19;3(1):23-31. (PMID: 35243432)
Can J Cardiol. 2021 Feb;37(2):310-318. (PMID: 32360794)
Cardiovasc Diabetol. 2021 Feb 11;20(1):39. (PMID: 33573667)
J Am Heart Assoc. 2018 Jun 15;7(12):. (PMID: 29907655)
JAMA. 2019 Jan 1;321(1):69-79. (PMID: 30418475)
Chronic Dis Can. 2009;29(4):178-91. (PMID: 19804682)
Health Rep. 2009 Dec;20(4):85-94. (PMID: 20108609)
Lancet. 2022 Sep 3;400(10354):757-767. (PMID: 36041474)
BMC Med Inform Decis Mak. 2015 Apr 17;15:31. (PMID: 25886580)
Chronic Dis Inj Can. 2014 Feb;34(1):12-22. (PMID: 24618377)
Cardiovasc Drugs Ther. 2023 Jun;37(3):561-569. (PMID: 35142921)

Alberta Kidney Disease Network; Interdisciplinary Chronic Disease Collaboration

Keywords: Atrial fibrillation; DPP4 inhibitor; Heart failure; Hospitalization; SGLT2 inhibitor; Type II diabetes

0 (Sodium-Glucose Transporter 2 Inhibitors)
0 (Dipeptidyl-Peptidase IV Inhibitors)
IY9XDZ35W2 (Glucose)
9NEZ333N27 (Sodium)
0 (Hypoglycemic Agents)

Date Created: 20240314 Date Completed: 20240318 Latest Revision: 20240328

20240329

PMC10939462

10.1093/europace/euae054

38484180