Mariani Marco Valerio, Manzi Giovanna, Pierucci Nicola, Laviola Domenico, Piro Agostino, D'Amato Andrea, Filomena Domenico, Matteucci Andrea, Severino Paolo, Miraldi Fabio, Vizza Carmine Dario, Lavalle Carlo
Department of Cardiovascular, Respiratory, Nephrological, Aenesthesiological and Geriatric Sciences, "Sapienza" University of Rome, Rome, Italy.
Clinical and Rehabilitation Cardiology Division, San Filippo Neri Hospital, Rome, Italy.
J Cardiovasc Electrophysiol. 2024 Sep;35(9):1754-1765. doi: 10.1111/jce.16344. Epub 2024 Jun 28.
Gliflozins are recommended as first-line treatment in patients with heart failure and/or cardiovascular comorbidities and are demonstrated to reduce atrial fibrillation (AF) occurrence. However, it is not well known which gliflozin yields the larger cardioprotection in terms of AF occurrence reduction. Hence, we aimed to compare data regarding AF recurrence associated with different gliflozins.
An accurate search of online scientific libraries (from inception to June 1, 2023) was performed. Fifty-nine studies were included in the meta-analysis involving 108 026 patients, of whom 60 097 received gliflozins and 47 929 received placebo.
Gliflozins provided a statistically significant reduction of AF occurrence relative to standard of care therapy in the overall population (relative risks [RR]: 0.8880, 95% CI: [0.8059; 0.9784], p = .0164) and in patients with diabetes and cardiorenal diseases (RR: 0.8352, 95% CI: [0.7219; 0.9663], p = .0155). Dapagliflozin significantly decreased AF occurrence as compared to placebo (0.7259 [0.6337; 0.8316], p < .0001) in the overall population, in patients with diabetes (RR: 0.2482, 95% CI: [0.0682; 0.9033], p = .0345), with diabetes associated with cardiorenal diseases (RR: 0.7192, 95% CI: [0.5679; 0.9110], p = .0063) and in the subanalysis including studies with follow-up ≥1 year (RR: 0.7792, 95% CI: [0.6508; 0.9330], p = .0066). No significant differences in terms of AF protection were found among different gliflozins.
Dapagliflozin use was associated with significant reduction in AF risk as compared to placebo in overall population and patients with diabetes, whereas the use of other gliflozins did not significantly reduce AF occurrence.
格列净类药物被推荐作为心力衰竭和/或心血管合并症患者的一线治疗药物，并且已证明可降低心房颤动（AF）的发生率。然而，就降低AF发生率而言，哪种格列净类药物具有更大的心脏保护作用尚不清楚。因此，我们旨在比较与不同格列净类药物相关的AF复发数据。
对在线科学图书馆进行了精确检索（从数据库建立至2023年6月1日）。纳入荟萃分析的59项研究涉及108026例患者，其中60097例接受格列净类药物治疗，47929例接受安慰剂治疗。
在总体人群中（相对风险[RR]：0.8880，95%置信区间[CI]：[0.8059；0.9784]，p = 0.0164）以及糖尿病和心肾疾病患者中（RR：0.8352，95%CI：[0.7219；0.9663]，p = 0.0155），与标准治疗相比，格列净类药物使AF发生率有统计学意义的降低。在总体人群中、糖尿病患者中（RR：0.2482，95%CI：[0.0682；0.9033]，p = 0.0345）、患有糖尿病合并心肾疾病的患者中（RR：0.7192，95%CI：[0.5679；0.9110]，p = 0.0063）以及在随访≥1年的研究亚分析中（RR：0.7792，95%CI：[0.6508；0.9330]，p = 0.0066），与安慰剂相比，达格列净显著降低了AF发生率。不同格列净类药物在AF保护方面未发现显著差异。
与安慰剂相比，在总体人群和糖尿病患者中，使用达格列净可显著降低AF风险，而使用其他格列净类药物并未显著降低AF发生率。
