SGLT2 inhibition could lower stroke risk in those with diabetes plus atrial fibrillation
Key takeaways:
- SGLT2 inhibition was tied to a decreased rate of stroke among patients with atrial fibrillation and diabetes.
- SGLT2 inhibitor use was associated with a 20% reduced risk for stroke at 5 years.
SGLT2 inhibition was associated with reduced 5-year risk for stroke among patients with concomitant atrial fibrillation and diabetes, according to a study in the Journal of the American Heart Association.
“From the animal studies, SGLT2 inhibitors could decrease oxidative stress in cardiomyocytes, reverse myocardial remodeling and reduce electronic alterations. These pleiotropic effects of SGLT2 inhibitors are theoretically beneficial for decreasing AF occurrence and subsequently sequelae,” Sheng-Nan Chang, MD, of the division of cardiology in the department of internal medicine at National Taiwan University Hospital in Yun-Lin, Taiwan, and colleagues wrote. “However, none of these studies were particularly designed to evaluate the direct effects of SGLT2 inhibitors on AF. Whether SGLT2 inhibitors could decrease the risk of stroke or systemic embolization in patients with diabetes and AF remains unknown.”
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The present analysis included 9,116 patients with concomitant AF and diabetes from the National Taiwan University historical cohort with 5 years of follow-up (mean age, 73 years; 61% men). Risk for the primary endpoint of ischemic stroke related to SGLT2 inhibition was evaluated in matched cohorts of SGLT2 inhibitor users and nonusers.
Patients taking empagliflozin (Jardiance, Boehringer Ingelheim/Eli Lilly) and dapagliflozin (Farxiga, AstraZeneca) were grouped together, and no patients were taking canagliflozin (Invokana, Janssen) because it was late on the Taiwan market, according to the study.
Baseline characteristics, including CHA2DS2-VASc score, were similar between SGLT2 users and nonusers.
During 5 years of follow-up, the rate of stroke was lower within the SGLT2 inhibitor user cohort compared with the nonuser group (3.4% vs. 4.3%; P = .021), according to the study.
After adjustment for CHA2DS2-VASc score, SGLT2 inhibitor use was associated with an approximately 20% reduction in risk for stroke during follow-up compared with nonuse (adjusted HR = 0.8; 95% CI, 0.64-0.99; P = .043).
“This was the first and largest study specifically aiming to investigate the relationship between SGLT2 inhibition and embolic events among patients with diabetes and AF,” the researchers wrote. “Our results showed that SGLT2 inhibition decreased the risk of ischemic stroke after adjustment of CHA2DS2-VASc score. Therefore, we recommended to upgrade SGLT2 inhibition for glycemic control in clinical practice, especially for the patients with diabetes and AF.”
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