SGLT2 inhibitors associated with reduced AF risk in older patients with type 2 diabetes
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SGLT2 inhibition in older patients with type 2 diabetes was associated with lower risk for incident atrial fibrillation compared with dipeptidyl peptidase IV inhibition or GLP-1 receptor agonist treatment, researchers reported.
“The role of SGLT2 inhibitors in incident AF remains controversial,” Min Zhuo, MD, MPH, nephrologist and pharmacoepidemiologist at Brigham and Women’s Hospital, and colleagues wrote in a study published in JAMA Network Open. “Incident AF was not a common event in randomized clinical trials, further limiting the ability to assess this outcome robustly. Head-to-head trials comparing SGLT2 inhibitors with other anti-diabetes drugs also were lacking. Thus, we sought to quantify SGLT2 inhibitor initiation with incident AF compared with two active comparators in a nationwide cohort of older adults with type 2 diabetes.”
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Zhuo and colleagues conducted a population-based new-user cohort study of older adults with type 2 diabetes and no prior AF enrolled in Medicare fee-for-service to evaluate the incidence of AF after SGLT2 inhibitor initiation compared with dipeptidyl peptidase IV (DPP-IV) inhibition or treatment with a GLP-1 receptor agonist.
New users of SGLT2 inhibitors were propensity score matched to new users of a DPP-IV inhibitors, for a total of 74,868 matched pairs, or matched to new users of GLP-1 receptor agonists, for a total of 80,475 pairs. In the overall cohort, the mean age was 72 years and 53.4% were women.
The primary outcome was incident AF, defined as an inpatient diagnosis of AF.
The incidence rate was lower in the SGLT2 inhibitor group compared with the matched DPP-IV inhibitor group (16.8 per 1,000 person-years vs. 20.5 per 1,000 person-years; HR = 0.82; 95% CI, 0.76-0.89).
In addition, the incidence rate was lower in the SGLT2 inhibitor group compared with the matched GLP-1 receptor agonist group (17 per 1,000 person-years vs. 18.7 per 1,000 person-years; HR = 0.9; 95% CI, 0.83-0.98).
These findings were consistent across multiple sensitivity analyses and researchers observed no effect heterogeneity in the association between SGLT2 inhibitors and incident AF by age, sex, history of HF or history of atherosclerotic CVD, according to the study.
“Study findings were robust to a range of predefined sensitivity analyses and did not appear to differ substantially across subgroups,” the researchers wrote. “A glucose-lowering medication preventing AF would be advantageous for older adults with type 2 diabetes. To our knowledge, our study is the first clinical practice investigation to describe the risk of AF in older patients (mean age, 72 years) with type 2 diabetes who began SGLT2 inhibitor therapy. Our results are consistent with a previous study using the U.S. Food and Drug Administration adverse event reporting system, which supports a protective role of SGLT2 inhibitors against the occurrence of AF.”
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