Amsterdam UMC, Academic Medical Center, University of Amsterdam, Department of Experimental and Clinical Cardiology, Heart Centre, Amsterdam Cardiovascular Sciences, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, Gentofte Hospitalsvej 6, PO Box 635, DK-2900 Hellerup, Denmark.
Eur Heart J Cardiovasc Pharmacother. 2024 Jul 16;10(4):289-295. doi: 10.1093/ehjcvp/pvae022.
Sodium-glucose cotransporter-2 inhibitors (SGLT-2is) have a direct cardiac effect that is likely to be independent of its glucose lowering renal effect. Previous research has shown that SGLT2-is mitigate heart failure and prevent arrhythmic cardiac death. Our objective is to determine whether SGLT-2is reduce atrial fibrillation (AF) in comparison to other second-to third-line antidiabetic drugs in type 2 diabetes.
We conducted a population-based, new-user active comparator cohort study using data from the UK Clinical Practice Research Datalink. We identified a cohort of patients initiating a new antidiabetic drug class between January 2013 and September 2020. This cohort included patients initiating their first ever non-insulin antidiabetic drug, as well as those who switched to or added-on an antidiabetic drug class not previously used in their treatment history. Individuals with a diagnosis of AF or atrial flutter at any time before cohort entry were excluded. Cox regression analysis with time-dependent covariates was used to estimate hazard ratios (HRs) and 95% confidence intervals (95% CIs) of AF comparing SGLT-2-is with other second-line to third-line antidiabetic drugs. Stratified analyses were performed according to sex, diabetes duration (<5 or ≥ 5 years), body mass index (BMI), HbA1c, and presence of heart failure.The cohort comprised 142 447 patients. SGLT-2is were associated with a statistically significant reduced hazard of AF compared to other second-line to third-line antidiabetic drugs (adjusted HR: 0.77 [95% CI: 0.68-0.88]). This reduced risk was present in both sexes but was more prominently among women (adjusted HRwomen: 0.60 [95% CI: 0.45-0.79]; HRmen: 0.85 [95% CI: 0.73-0.98]; P-value interaction: 0.012). There was no evidence for effect modification when stratifying on duration of diabetes, BMI, HbA1c, or presence of heart failure.
SGLT-2is were associated with a reduced risk of AF in patients with type 2 diabetes compared to other second-line to third-line antidiabetic drugs. This reduced risk occurs in both sexes but more prominently among women.
钠-葡萄糖共转运蛋白 2 抑制剂（SGLT-2is）具有直接的心脏作用，可能独立于其降低血糖的肾脏作用。先前的研究表明，SGLT2-is 可减轻心力衰竭并预防心律失常性心脏死亡。我们的目的是确定与其他二线至三线抗糖尿病药物相比，SGLT-2is 是否可降低 2 型糖尿病患者的心房颤动（AF）。
我们使用来自英国临床实践研究数据链接的基于人群的新用户活性对照队列研究进行了研究。我们确定了一组在 2013 年 1 月至 2020 年 9 月期间开始使用新的抗糖尿病药物类别的患者队列。该队列包括首次使用非胰岛素抗糖尿病药物的患者，以及那些转换或添加以前未在其治疗史中使用过的抗糖尿病药物类别的患者。在队列入组之前的任何时间均排除有 AF 或心房扑动诊断的患者。使用具有时间依赖性协变量的 Cox 回归分析来估算 SGLT-2is 与其他二线至三线抗糖尿病药物相比 AF 的风险比（HR）和 95％置信区间（95％CI）。根据性别，糖尿病病程（<5 年或≥5 年），体重指数（BMI），HbA1c 和心力衰竭的存在进行分层分析。该队列包括 142447 名患者。与其他二线至三线抗糖尿病药物相比，SGLT-2is 与 AF 的发生风险显著降低相关（调整后的 HR：0.77 [95％CI：0.68-0.88]）。这种风险降低在两性中均存在，但在女性中更为明显（调整后的 HRwomen：0.60 [95％CI：0.45-0.79]；HRmen：0.85 [95％CI：0.73-0.98]；P 值交互作用：0.012）。在按糖尿病病程，BMI，HbA1c 或心力衰竭的存在进行分层时，没有证据表明存在效应修饰。
与其他二线至三线抗糖尿病药物相比，SGLT-2is 可降低 2 型糖尿病患者的 AF 风险。这种风险降低在两性中均存在，但在女性中更为明显。
