Sodium-glucose co-transporter-2 inhibitors and atrial fibrillation in the cardiovascular and renal outcome trials.
Victor OkunrintemiBasem M MishrikyJames R PowellDoyle M CummingsPublished in: Diabetes, obesity & metabolism (2020)
Dapagliflozin is a sodium-glucose co-transporter-2 (SGLT2) inhibitor 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 SGLT2 inhibitors can reduce the incidence of AF in a high-risk population. We searched for trials comparing SGLT2 inhibitors to placebo in high-risk individuals with or without diabetes (ie, cardiovascular and renal outcome trials) and that reported the incidence of AF as a serious adverse event. The EMPA-REG OUTCOME trial, CANVAS, CANVAS-R, the DECLARE-TIMI 58 trial, CREDENCE, DAPA-HF, VERTIS-CV and DAPA-CKD were included. The incidence of AF, reported as a serious adverse event, was 0.9% in individuals who received an SGLT2 inhibitor compared to 1.1% in those who received placebo. Pooled results showed a significantly lower incidence of AF in individuals with and without diabetes (relative risk 0.79, 95% confidence interval 0.67,0.93). This review suggests that there is a significantly lower risk of incident AF for individuals on SGLT2 inhibitors 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.
Keyphrases
- atrial fibrillation
- phase iii
- catheter ablation
- risk factors
- left atrial
- oral anticoagulants
- left atrial appendage
- direct oral anticoagulants
- cardiovascular disease
- heart failure
- clinical trial
- percutaneous coronary intervention
- phase ii
- double blind
- open label
- coronary artery disease
- metabolic syndrome
- chronic kidney disease
- glycemic control
- insulin resistance
- placebo controlled
- weight loss
- acute coronary syndrome
- mitral valve