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SGLT2 inhibitors and atrial fibrillation in type 2 diabetes: a systematic review with meta-analysis of 16 randomized

Wen-Jie Li1, Xing-Qing Chen2, Ling-Ling Xu2

  • 1Nanshan School, Guangzhou Medical University, Jingxiu Road, Panyu District, Guangzhou, Guangdong, China.

Cardiovascular Diabetology
|August 28, 2020
PubMed
Abstract

Insights

Sodium-glucose cotransporter 2 (SGLT2) inhibitors significantly reduce atrial fibrillation (AF) and atrial flutter (AFL) in patients with type 2 diabetes. This benefit is observed across various patient profiles and may be linked to improved metabolic and cardiovascular markers.

Area of Science:

  • Cardiology
  • Endocrinology
  • Pharmacology

Background:

  • Type 2 diabetes (T2D) is associated with a higher risk of atrial fibrillation (AF) and atrial flutter (AFL).
  • The potential of sodium-glucose cotransporter 2 (SGLT2) inhibitors to mitigate AF/AFL progression in T2D patients requires further investigation.

Purpose of the Study:

  • To evaluate the efficacy of SGLT2 inhibitors in reducing the incidence of AF/AFL in patients with type 2 diabetes.
  • To assess the impact of SGLT2 inhibitors on other cardiovascular and metabolic parameters in this patient population.

Main Methods:

  • A systematic search of electronic databases (PubMed, Embase, ClinicalTrials.gov) was conducted up to January 2020.
  • Meta-analysis of 16 trials involving 38,335 patients with type 2 diabetes was performed.
  • Relative risks (RRs) and weighted mean differences (WMDs) with 95% confidence intervals (CIs) were calculated.

Main Results:

  • SGLT2 inhibitors significantly reduced AF/AFL incidence (RR: 0.76; 95% CI 0.65-0.90) and all-cause mortality (RR: 0.91; 95% CI 0.83-0.99).
  • Reductions in AF/AFL were consistent across subgroups defined by age, body weight, HbA1c, and SBP.
  • SGLT2 inhibitors also demonstrated significant reductions in heart failure events, HbA1c, body weight, and blood pressure (SBP and DBP).

Conclusions:

  • SGLT2 inhibitors may offer a specific benefit in reducing AF/AFL in type 2 diabetes patients, irrespective of baseline characteristics.
  • The observed AF/AFL-reduction benefit might be partly mediated by improvements in glycemic control, weight, blood pressure, and reduced heart failure incidence.
Keywords:
Atrial fibrillationAtrial flutterMeta-analysisSodium-glucose cotransporter 2 inhibitorsType 2 diabetes

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