SGLT2 inhibitors may protect T2D patients with AF from HF and renal complications: Study

A recent study found a significant discovery in the treatment of patients with from type 2 diabetes (T2D) with concurrent atrial fibrillation (AF) which is a combination that markedly increases the risk of adverse cardiovascular events. The major outcomes of this study were published in The Journal of Clinical Endocrinology and Metabolism.

This comprehensive nationwide retrospective cohort study utilized data from the Taiwan National Health Insurance Research Database and the findings highlight the comparative effects of sodium-glucose cotransporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1RA) on the patients with and without AF.

The study spanned from May 1, 2016 to December 31, 2019 and observed a total of 344,392 T2D patients without AF and a total of 31,351 with AF treated with SGLT2i, along with 11,462 and 816 T2D patients with and without AF, respectively with GLP-1RA administration. The participants were monitored up to December 31, 2020 for various cardiovascular outcomes after employing propensity score stabilized weighting to ensure the equitable comparison between the two medication groups.

The results unveiled a striking distinction in treatment outcomes, specially for the patients with concomitant AF. The individuals treated with SGLT2i experienced a significantly reduced risk of hospitalization for heart failure when compared to their counterparts on GLP-1RA with an incidence rate of 2.32 versus 4.74 events per 100 person-years. SGLT2i was associated with a lower risk of composite kidney outcomes in both groups that highlights its benefits beyond heart health.

This study observed no significant difference between the two drugs in terms of major adverse cardiovascular events and all-cause mortality, regardless of AF status. This neutrality illuminates the complexity of T2D management along with cardiovascular conditions and highlights the need for personalized treatment strategies.

The positive effects of these findings are significant in diabetic patients with the high prevalence and risk of heart failure. This evidence strongly suggests that SGLT2i may offer superior protection against heart failure and renal complications for the T2D patients with AF which elevated the risk for these debilitating conditions. However, this study warrants further investigation to conclusively determine whether SGLT2i should be the preferred treatment option over GLP-1RA for this high-risk demographic.

Source:

Chan, Y.-H., Chao, T.-F., Chen, S.-W., Lee, H.-F., Li, P.-R., Yeh, Y.-H., Kuo, C.-T., See, L.-C., & Lip, G. Y. H. (2024). SGLT2 inhibitors vs. GLP-1 receptor agonists and clinical outcomes in patients with diabetes with/without atrial fibrillation. In The Journal of Clinical Endocrinology & Metabolism. The Endocrine Society. https://doi.org/10.1210/clinem/dgae157