Lee Ji Yun, Lee Ju-Hyun, Jung Eun-Jung, Park Woochan, Seo Jeongmin, Kang Minsu, Jung Eun Hee, Kim Sang-A, Suh Koung Jin, Kim Ji-Won, Kim Se Hyun, Lee Jeong-Ok, Kim Jin Won, Kim Yu Jung, Lee Keun-Wook, Kim Jee Hyun, Bang Soo-Mee
Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-Si, 13620, Gyeonggi-do, Korea.
Cardiovasc Diabetol. 2025 Jul 10;24(1):276. doi: 10.1186/s12933-025-02805-6.
Sodium-glucose cotransporter 2 (SGLT-2) inhibitors, widely used for type 2 diabetes and cardiorenal conditions, may induce erythrocytosis, potentially increasing cardiovascular risk. This study investigates its prevalence, risk factors, and thrombotic implications.
In a single-center retrospective study, we analyzed 6787 patients prescribed SGLT-2 inhibitors (2014-2024). Erythrocytosis was defined as hemoglobin > 16.5 g/dL or hematocrit > 49% in men, > 16.0 g/dL or > 48% in women. We assessed prevalence, risk factors, and thrombotic events using logistic regression.
Erythrocytosis occurred in 1145 patients (16.9%) over a median follow-up of 530 days (IQR, 277-981), with a median hemoglobin rise of 1.0 g/dL (IQR, 0.4-1.8). Male sex (OR 3.24, 95% CI 2.47-4.26), BMI ≥ 25 kg/m (OR 1.97, 95% CI 1.63-2.39), and current smoking (OR 2.41, 95% CI 1.96-2.96) significantly increased risk (all p < 0.001), while age ≥ 70 years, hypertension, dyslipidemia, and chronic kidney disease were associated with reduced risk. Thrombosis was rare (0.5%, 33 patients) and associated with antiplatelet use (OR 3.57, 95% CI 1.60-7.97), anticoagulant use (OR 5.93, 95% CI 2.60-13.57), and baseline erythrocytosis (OR 3.75, 95% CI 1.41-9.96). Among 33 patients with thrombosis, five exhibited erythrocytosis at the time of the event and within the prior six months; all had arterial thrombosis associated with underlying conditions (atrial fibrillation, coronary calcification, atherosclerosis), not directly attributable to SGLT-2-induced erythrocytosis.
SGLT-2 inhibitors are associated with a 16.9% prevalence of erythrocytosis, but thrombotic risk appears primarily driven by pre-existing conditions.
钠-葡萄糖协同转运蛋白2（SGLT-2）抑制剂广泛用于2型糖尿病和心肾疾病，可能诱发红细胞增多症，从而潜在增加心血管风险。本研究调查其发生率、危险因素及血栓形成的影响。
在一项单中心回顾性研究中，我们分析了6787例开具SGLT-2抑制剂处方的患者（2014 - 2024年）。红细胞增多症定义为男性血红蛋白>16.5 g/dL或血细胞比容>49%，女性血红蛋白>16.0 g/dL或血细胞比容>48%。我们使用逻辑回归评估发生率、危险因素和血栓形成事件。
在中位随访530天（四分位间距，277 - 981天）期间，1145例患者（16.9%）发生红细胞增多症，血红蛋白中位升高1.0 g/dL（四分位间距，0.4 - 1.8）。男性（比值比3.24，95%置信区间2.47 - 4.26）、体重指数≥25 kg/m（比值比1.97，95%置信区间1.63 - 2.39）和当前吸烟（比值比2.41，95%置信区间1.96 - 2.96）显著增加风险（均p<0.001），而年龄≥70岁、高血压、血脂异常和慢性肾脏病与风险降低相关。血栓形成罕见（0.5%，33例患者），与使用抗血小板药物（比值比3.57，95%置信区间1.60 - 7.97）、抗凝药物（比值比5.93，95%置信区间2.60 - 13.57）及基线红细胞增多症（比值比3.75，95%置信区间1.41 - 9.96）相关。在33例发生血栓形成的患者中，5例在事件发生时及之前6个月内出现红细胞增多症；所有患者均有与基础疾病（心房颤动、冠状动脉钙化、动脉粥样硬化）相关的动脉血栓形成，并非直接归因于SGLT-2诱导的红细胞增多症。
SGLT-2抑制剂与16.9%的红细胞增多症发生率相关，但血栓形成风险似乎主要由基础疾病驱动。
