SGLT2 Inhibitors may Cut Risk of Arrhythmias and Cardiac Arrest in High-Risk Patients, Study Finds

The findings were published online in Reviews in Cardiovascular Medicine.

Sodium-glucose cotransporter 2 inhibitors (SGLT2i) are the hypoglycemic agents widely used for T2D treatment. In addition to lowering blood glucose, SGLT2i protects the kidney and heart, significantly reduces cardiovascular (CV) events, and delays progression to HF and CKD.

In addition to lowering blood glucose, SGLT2i protects the heart and kidney, significantly reduces cardiovascular events, and delays the progression of heart failure and chronic kidney disease. However, prior research has not thoroughly explored the link between SGLT2 inhibitors and the risk of developing cardiac arrhythmias.

Against the above background, Xujie Wang, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China, and colleagues aimed to assess the association of SGLT2i with cardiac arrhythmias in patients with type 2 diabetes and without T2DM in cardiovascular outcome trials (CVOTs).

For this purpose, they performed a meta-analysis and systematic review of CVOTs that compared SGLT2 inhibitors with placebo. Online databases were systematically searched from their inception through December 2022. The review focused on CVOTs that reported on cardiovascular or renal outcomes and had a follow-up period of at least six months.

The meta-analysis included 12 CVOTs with 77,470 participants (42,016 SGLT2i versus 35,454 control), including patients with T2DM, heart failure, or chronic kidney disease. Follow-up duration ranged from 9 months to 5.65 years.

The researchers reported the following findings:

• Medications included empagliflozin, canagliflozin, dapagliflozin, and ertugliflozin.
• SGLT2i were associated with a lower risk of tachycardia (risk ratio (RR) 0.86), supraventricular tachycardia (SVT; RR 0.84), atrial fibrillation (AF; RR 0.86) and atrial flutter (AFL; RR 0.75) in patients with T2DM, HF, and CKD. SGLT2i could also reduce the risk of cardiac arrest in CKD patients (RR 0.50).
• SGLT2i therapy was not associated with a lower risk of ventricular arrhythmia and bradycardia.

"These results offer strong support for the use of SGLT2 inhibitors in lowering the risk of cardiovascular disease in patients with type 2 diabetes mellitus, heart failure, and chronic kidney disease. Further prospective trials are necessary to verify the antiarrhythmic effects of SGLT2 inhibitors and to understand their underlying mechanisms better," the researchers concluded.

Reference:

Wang, Xujie, et al. "Association of Sodium-Glucose Cotransporter 2 Inhibitors (SGLT2i) With Cardiac Arrhythmias: a Systematic Review and Meta-Analysis of Cardiovascular Outcome Trials." Reviews in Cardiovascular Medicine, vol. 24, no. 9, 2023, p. 258.