Song Haegeun, Kim Yoo Ri, Lee Seung Eun, Nam Hyewon, Kim Hoseob, Kyoung Dae-Sung, Kim Kyoung-Ah
Division of Cardiology, Department of Internal Medicine, Chung-Ang University, Gwang-Myong Hospital, 14353 Seoul, Republic of Korea.
Division of Cardiology, Department of Internal Medicine, Chonnam National University, 61469 Gwangju, Republic of Korea.
Rev Cardiovasc Med. 2022 Sep 9;23(9):303. doi: 10.31083/j.rcm2309303. eCollection 2022 Sep.
Type 2 diabetes (T2D) is an independent risk factor for the development of atrial fibrillation (AF). Sodium-glucose cotransporter-2 inhibitors (SGLT-2i) have recently been shown to decrease the incidence of AF through several mechanisms, including the reduction of atrial dilatation via diuresis and the lowering of body weight. In observational studies of diabetic patients, the use of thiazolidinedione (TZD) was found to have a protective effect on new-onset AF. In this study, we aimed to compare the effect of SGLT-2i and TZD on the risk of AF in patients with T2D.
We enrolled 69,122 patients newly prescribed SGLT-2i and 94,262 patients prescribed TZD from January 2014 to December 2018, using the Korean National Health Insurance Service database. We compared new-onset AF events (hospitalizations and outpatient events) in SGLT-2i and TZD groups after having taken medication for greater than 90 days.
During a mean follow-up of 1.8 years, 397 (0.72%) new-onset AF events occurred in the SGLT-2i group and 432 (0.79%) events in the TZD group following propensity score matching (each group n = 54,993). The hazard ratio (HR) of AF was 0.918 (95% confidence interval: 0.783-1.076, = 0.29) in SGLT-2i-treated patients compared with TZD-treated patients.
In this study, the risk of new-onset AF is comparable in patients treated with SGLT-2i and TZD in T2D. Either SGLT-2i or TZD would be a reasonable choice for T2D patients who are at risk for AF.
2型糖尿病（T2D）是心房颤动（AF）发生的独立危险因素。钠-葡萄糖协同转运蛋白2抑制剂（SGLT-2i）最近被证明可通过多种机制降低房颤发生率，包括通过利尿减少心房扩张和减轻体重。在糖尿病患者的观察性研究中，发现使用噻唑烷二酮（TZD）对新发房颤有保护作用。在本研究中，我们旨在比较SGLT-2i和TZD对T2D患者房颤风险的影响。
我们使用韩国国民健康保险服务数据库，纳入了2014年1月至2018年12月新开具SGLT-2i处方的69122例患者和开具TZD处方的94262例患者。我们比较了服用药物超过90天后SGLT-2i组和TZD组的新发房颤事件（住院和门诊事件）。
在平均1.8年的随访期间，倾向得分匹配后（每组n = 54993），SGLT-2i组发生397例（0.72%）新发房颤事件，TZD组发生432例（0.79%）事件。与TZD治疗的患者相比，SGLT-2i治疗的患者房颤的风险比（HR）为0.918（95%置信区间：0.783-1.076，P = 0.29）。
在本研究中，T2D患者使用SGLT-2i和TZD治疗时新发房颤的风险相当。对于有房颤风险的T2D患者，SGLT-2i或TZD都是合理的选择。
