Kim Sunyoung, Park So Young, Kim Bongseong, Min Chanyang, Cho Wonyoung, Yon Dong Keon, Kim Joo Young, Han Kyung-Do, Rhee Eun-Jung, Lee Won-Young, Rhee Sang Youl
Department of Family Medicine, Kyung Hee University College of Medicine, Kyung Hee University Medical Center, Seoul, Republic of Korea; Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Seoul, Republic of Korea.
Department of Endocrinology and Metabolism, Kyung Hee University College of Medicine, Kyung Hee University Medical Center, Seoul, Republic of Korea.
Diabetes Res Clin Pract. 2023 Apr;198:110626. doi: 10.1016/j.diabres.2023.110626. Epub 2023 Mar 16.
Although diabetes is a risk factor for atrial fibrillation (AF), studies on the AF risk according to the antidiabetic drugs are lacking. This study evaluated the effects of antidiabetic drugs on AF incidence in Korean patients with type 2 diabetes.
We included 2,515,468 patients with type 2 diabetes from the Korean National Insurance Service database without a history of AF who underwent health check-ups between 2009 and 2012. Newly diagnosed AF incidence was recorded until December 2018 according to the main antidiabetic drug combinations used in the real world.
Of the patients included (mean age, 62 ± 11 years; 60 % men), 89,125 were newly diagnosed with AF. Metformin (MET) alone (hazard ratio [HR] 0.959, 95 % CI 0.935-0.985) and MET combination therapy (HR < 1) significantly decreased the risk of AF compared to the no-medication group. The antidiabetic drugs consistently showing a protective effect against AF incidence were MET (HR 0.977, 95 % CI 0.964-0.99) and thiazolidinedione (TZD; HR 0.926, 95 % CI 0.898-0.956), even after adjusting for various factors. Moreover, this protective effect was more remarkable with MET and TZD combination therapy (HR 0.802, 95 % CI 0.754-0.853) than with other drug combinations. In the subgroup analysis, the preventive effect of MET and TZD treatment against AF remained consistent, regardless of age, sex, duration, and diabetes severity.
The combination therapy of MET and TZD is the most effective antidiabetic drug for preventing AF in patients with type 2 diabetes.
尽管糖尿病是心房颤动（AF）的一个危险因素，但关于抗糖尿病药物与AF风险的研究仍很缺乏。本研究评估了抗糖尿病药物对韩国2型糖尿病患者AF发生率的影响。
我们纳入了2009年至2012年间韩国国民健康保险服务数据库中2,515,468例无AF病史且接受健康检查的2型糖尿病患者。根据现实世界中使用的主要抗糖尿病药物组合，记录截至2018年12月新诊断的AF发生率。
纳入的患者（平均年龄62±11岁；60%为男性）中，89,125例新诊断为AF。与未用药组相比，单独使用二甲双胍（MET）（风险比[HR]0.959，95%可信区间[CI]0.935 - 0.985）和MET联合治疗（HR<1）显著降低了AF风险。即使在调整各种因素后，持续显示对AF发生率有保护作用的抗糖尿病药物是MET（HR 0.977，95%CI 0.964 - 0.99）和噻唑烷二酮（TZD；HR 0.926，95%CI 0.898 - 0.956）。此外，与其他药物组合相比，MET和TZD联合治疗的这种保护作用更显著（HR 0.802，95%CI 0.754 - 0.853）。在亚组分析中，无论年龄、性别、病程和糖尿病严重程度如何，MET和TZD治疗对AF的预防作用均保持一致。
MET和TZD联合治疗是预防2型糖尿病患者AF最有效的抗糖尿病药物。
