Dapagliflozin reduces AF events in high-risk patients with diabetes
Click Here to Manage Email Alerts
High-risk patients with diabetes who were treated with dapagliflozin had a decrease in the incidence of atrial fibrillation and atrial flutter, according to an analysis of the DECLARE-TIMI 58 trial published in Circulation.
“Although the mechanisms of benefit (eg, direct antiarrhythmic effects, cardiac remodeling) remain uncertain, dapagliflozin appears to reduce the risk of AF/atrial flutter in a broad population of patients with type 2 diabetes,” Thomas A. Zelniker, MD, MSc, a fellow of the TIMI Study Group at Brigham and Women’s Hospital and Harvard Medical School at the time of the study and now a cardiologist at the Medical University of Vienna, told Healio. “This adds another potential benefit for this class of drugs in patients with diabetes.”
Findings from DECLARE-TIMI 58
As Healio previously reported, results from the DECLARE-TIMI 58 trial linked dapagliflozin 10 mg (Farxiga, AstraZeneca), as compared with placebo, to a significant 17% relative risk reduction in the coprimary efficacy endpoint of a composite of CV death or hospitalization for HF (4.9% vs. 5.8%; HR = 0.83; 95% CI, 0.73-0.95; P = .005 for superiority) after a median of 4.2 years of follow-up.
In this analysis, researchers analyzed patients’ data from the trial (n = 17,160) to compare those with and without AF or atrial flutter. A diagnosis of AF or atrial flutter was the primary outcome.
At baseline, 6.5% of patients had a history of AF or atrial flutter.
During follow-up, patients assigned dapagliflozin had a 19% reduced risk for a first AF or atrial flutter event compared with those assigned placebo (264 events vs. 325 events; 7.8 events per 1,000 patient-years vs. 9.6 events per 1,000 patient-years; HR = 0.81; 95% CI, 0.68-0.95).
Risk reduction was consistent regardless of the presence (HR = 0.79; 95% CI, 0.58-1.09) or absence of a history of AF or atrial flutter at baseline (HR = 0.81; 95% CI, 0.67-0.98; P for interaction = .89). This was also consistent in the presence of atherosclerotic CVD (HR = 0.83; 95% CI, 0.66-1.04) vs. multiple ASCVD risk factors (HR = 0.78; 95% CI, 0.62-0.99) or a history of HF (HR = 0.78; 95% CI, 0.55-1.11). The effect of dapagliflozin on AF or atrial flutter was not affected by a history of ischemic stroke, sex, BMI, HbA1c or estimated glomerular filtration rate.
AF events with dapagliflozin
The total number of AF and atrial flutter events was also reduced in patients assigned dapagliflozin vs. those assigned placebo (337 events vs. 432 events; incidence rate ratio = 0.77; 95% CI, 0.64-0.92).
“Although these data come from a large and well-characterized trial, AF was not a prespecified outcome in this trial,” Zelniker said in an interview. “Therefore, additional randomized controlled trials focusing on this issue would be desirable to confirm this finding. Furthermore, mechanistic studies are necessary to add valuable insights and better understand this new drug class.” – by Darlene Dobkowski
For more information:
Thomas A. Zelniker, MD, MSc, can be reached at thomas.zelniker@meduniwien.ac.at.
Disclosures: The DECLARE-TIMI 58 trial was funded by a grant from AstraZeneca to Brigham and Women’s Hospital. Zelniker reports he received a research grant from Deutsche Forschungsgemeinschaft and lecture fees from AstraZeneca. Please see the study for all other authors’ relevant financial disclosures.
Collapse
Read more about
Click Here to Manage Email Alerts