Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, 3584 CS Utrecht, The Netherlands.
Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, 2900 Copenhagen, Denmark.
Eur Heart J Cardiovasc Pharmacother. 2022 Dec 15;9(1):18-25. doi: 10.1093/ehjcvp/pvac043.
Sodium-glucose cotransporter-2 inhibitors (SGLT-2is) are antidiabetic agents that can have direct cardiac effects by impacting on cardiac ion transport mechanisms that control cardiac electrophysiology. We studied the association between SGLT-2i use and all-cause mortality and the risk of sudden cardiac arrest (SCA) in patients with type 2 diabetes.
Using data from the UK Clinical Practice Research Datalink, a cohort study among patients initiating a new antidiabetic drug class on or after January 2013 through September 2020 was conducted. A Cox regression with time-dependent covariates was performed to estimate the hazard ratios (HRs) of SCA and all-cause mortality comparing SGLT-2is with other second- to third-line antidiabetic drugs. Stratified analyses were performed according to sex, diabetes duration (<5 or ≥5 years), and the presence of cardiovascular disease.
A total of 152 591 patients were included. Use of SGLT-2i was associated with a reduced HR of SCA when compared with other second- to third-line antidiabetic drugs after adjustment for common SCA risk factors, although this association marginally failed to reach statistical significance [HR: 0.62, 95% confidence interval (95% CI): 0.38-1.01]. The HR of all-cause mortality associated with SGLT-2i use when compared with other second- to third-line antidiabetics was 0.43 (95% CI: 0.39-0.48) and did not vary by sex, diabetes duration, or the presence of cardiovascular disease. SGLT-2i use remained associated with lower all-cause mortality in patients without concomitant insulin use (HR: 0.56, 95% CI: 0.50-0.63).
SGLT-2i use was associated with reduced all-cause mortality in patients with type 2 diabetes. The association between use of SGLT-2i and reduced risk of SCA was not statistically significant.
钠-葡萄糖共转运蛋白 2 抑制剂（SGLT-2i）是一种抗糖尿病药物，通过影响控制心脏电生理学的心脏离子转运机制，对心脏产生直接作用。我们研究了 SGLT-2i 应用与 2 型糖尿病患者全因死亡率和心源性猝死（SCA）风险之间的关联。
利用英国临床实践研究数据链接中的数据，我们对 2013 年 1 月至 2020 年 9 月期间新开始使用一种新型抗糖尿病药物类别的患者进行了队列研究。使用具有时间依赖性协变量的 Cox 回归来估计 SGLT-2i 与其他二线至三线抗糖尿病药物相比 SCA 和全因死亡率的风险比（HRs）。根据性别、糖尿病病程（<5 年或≥5 年）和心血管疾病的存在情况进行分层分析。
共纳入 152591 例患者。在调整常见 SCA 风险因素后，与其他二线至三线抗糖尿病药物相比，SGLT-2i 的应用与 SCA 的 HR 降低相关，尽管这种关联略微未达到统计学意义[HR：0.62，95%置信区间（95%CI）：0.38-1.01]。与其他二线至三线抗糖尿病药物相比，SGLT-2i 应用与全因死亡率相关的 HR 为 0.43（95%CI：0.39-0.48），且不受性别、糖尿病病程或心血管疾病的影响。在未同时使用胰岛素的患者中，SGLT-2i 的应用仍与较低的全因死亡率相关（HR：0.56，95%CI：0.50-0.63）。
SGLT-2i 的应用与 2 型糖尿病患者的全因死亡率降低相关。SGLT-2i 的应用与 SCA 风险降低之间的关联没有统计学意义。
