Lin Tsung-Kun, Lee Mei-Chun, Cheng Yu-Han, Ma Timothy, Chen Mei-Chun, Yang Tsung-Yuan, Jong Gwo-Ping
Department of Pharmacy, Taoyuan Armed Forces General Hospital, Taoyuan, Taiwan, ROC.
School of Pharmacy, National Defense Medical Center, Taipei, Taiwan, ROC.
Diabetol Metab Syndr. 2023 Aug 17;15(1):170. doi: 10.1186/s13098-023-01143-5.
Several observational cohorts and meta-analytical studies on humans have shown that users of sodium-glucose cotransporter-2 inhibitors (SGLT2is) have a lower risk for new-onset acute coronary syndrome (ACS) than nonusers. However, some studies, including randomized clinical trials, reported the opposite results. This study aimed to investigate the impacts of a SGLT2i on new-onset ACS in a population.
We conducted a retrospective population-based cohort study involving 56,356 subjects who received SGLT2i therapy and 112,712 patients who did not receive SGLT2i therapy between May 1, 2016 and December 31, 2019. The outcome was the risk of new-onset ACS. Multivariable Cox proportional hazards models were used to calculate hazard ratios (HRs) and 95% confidence intervals for associations between SGLT2i use and ACS risk.
A total of 670 and 1408 ACS events occurred in SGLT2i users and nonusers, respectively, during a follow-up of 3.7 years. SGLT2i use was associated with a nonsignificantly lower risk of ACS (adjusted HR 0.95, 95%confidence intervals (CI 0.87-1.04, P = 0.3218). We confirmed the robustness of these results through a propensity score 1:1 matching analysis. The results of the subgroup analysis of the subtype of the SGLT2i treatments were consistent with the main findings. An increased risk for the incidence of ACS in male and older (> 70 years) patients were also found.
In this population-based cohort study, we found that SGLT2i use is associated with a nonsignificantly decreased risk of ACS. No difference in the SGLT2i subtype was observed in subgroup analyses. However, the results of this study indicated an increased risk for the incidence of ACS in male and older (> 70 years) patients.
多项针对人类的观察性队列研究和荟萃分析表明，与未使用者相比，钠-葡萄糖协同转运蛋白2抑制剂（SGLT2i）使用者新发急性冠状动脉综合征（ACS）的风险更低。然而，包括随机临床试验在内的一些研究却报告了相反的结果。本研究旨在调查SGLT2i对人群中新发ACS的影响。
我们进行了一项基于人群的回顾性队列研究，纳入了2016年5月1日至2019年12月31日期间接受SGLT2i治疗的56356名受试者和未接受SGLT2i治疗的112712名患者。观察的结果是新发ACS的风险。采用多变量Cox比例风险模型计算SGLT2i使用与ACS风险之间关联的风险比（HR）和95%置信区间。
在3.7年的随访期间，SGLT2i使用者和非使用者分别发生了670例和1408例ACS事件。使用SGLT2i与ACS风险非显著降低相关（校正HR为0.95，95%置信区间为0.87 - 1.04，P = 0.3218）。我们通过倾向评分1:1匹配分析证实了这些结果的稳健性。SGLT2i治疗亚型的亚组分析结果与主要发现一致。还发现男性和年龄较大（>70岁）患者发生ACS的风险增加。
在这项基于人群的队列研究中，我们发现使用SGLT2i与ACS风险非显著降低相关。亚组分析未观察到SGLT2i亚型之间存在差异。然而，本研究结果表明男性和年龄较大（>70岁）患者发生ACS的风险增加。
