The ADA guidelines (2019) recommends that in patients with type 2 diabetes and atherosclerotic CV disease, sodium-glucose cotransporter 2 (SGLT-2) inhibitors or glucagon-like peptide 1 receptor agonists (GLP-1) are recommended. SGLT-2 inhibitors are preferred in patients with athersclerotic CV disease who are at risk of heart failure or if heart failure coexists. Considering SGLT-2 inhibitor or GLP-1 receptor agonist in patients with type 2 diabetes and chronic kidney disease is advised as It has shown to reduce risk of chronic kidney disease progression, CV events or both.
Dapagliflozin is a sodium‐glucose cotransporter‐2 inhibitor (SGLT‐2i) that has recently been shown to reduce the incidence of reported episodes of atrial fibrillation (AF)/atrial flutter in the DECLARE‐TIMI 58 trial. This raises the question regarding whether SGLT‐2i can reduce the incidence of AF in a high‐risk population like in patients with type 2 diabetes and at risk for cardiovascular disease.
To answer this, researchers searched for trials comparing SGLT‐2is to placebo in high‐risk individuals with or without diabetes (i.e., cardiovascular and renal outcome trials) and that reported the incidence of AF as a serious adverse event.
EMPA‐REG OUTCOME trial, CANVAS, CANVAS‐R, DECLARE‐TIMI 58 trial, CREDENCE, DAPA‐HF, VERTIS‐CV, and DAPA‐CKD were included.
Data analysis put forth the following facts.
- The incidence of AF, reported as a serious adverse event, was 0.9% in individuals who received an SGLT‐2i compared to 1.1% in those who received placebo.
- Pooled results showed a significantly lower incidence of AF in individuals with and without diabetes (RR[95%CI]=0.79[0.67,0.93]).
"This review suggests that there is a significantly lower risk of incident AF for individuals on SGLT‐2is versus placebo. While there was a statistically significant lower incidence of AF, reported as a serious adverse event, more research is needed to evaluate its clinical significance."wrote the authors.
For full article click on link: https://doi.org/10.1111/dom.14211
primary source: Diabetes, Obesity & Metabolism
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