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Sodium-Glucose Cotransporter-2 Inhibitors and Stroke Risk in Patients With Atrial Fibrillation

Ghee Kheng Lim1, Ramzi Ibrahim1, Xuan Ci Mee1

  • 1Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, Arizona, USA.

Journal of Cardiovascular Electrophysiology
|June 13, 2025
PubMed

Insights

Sodium-glucose cotransporter 2 inhibitors (SGLT2-Is) significantly reduce stroke risk in patients with atrial fibrillation (AF). SGLT2-Is also lower risks for mortality, hospitalizations, and cardiac arrest in this population.

Area of Science:

  • Cardiology
  • Pharmacology
  • Epidemiology

Background:

  • Sodium-glucose cotransporter 2 inhibitors (SGLT2-Is) are established treatments for type 2 diabetes mellitus (T2DM) and heart failure (HF).
  • The potential of SGLT2-Is to mitigate stroke risk in patients with atrial fibrillation (AF) is not well-established.
  • This study investigates the effect of SGLT2-Is on stroke risk in patients diagnosed with AF.

Purpose of the Study:

  • To evaluate the impact of SGLT2 inhibitors on stroke risk reduction in patients with atrial fibrillation.
  • To assess the association of SGLT2 inhibitors with other cardiovascular and non-cardiovascular outcomes in AF patients.

Main Methods:

  • A retrospective cohort study utilizing the TriNetX database.
  • Inclusion criteria: patients aged 18 years or older with AF on anticoagulation.
  • Propensity score matching (PSM) was employed to balance cohorts of SGLT2-Is users and non-users.

Main Results:

  • The study included 152,778 patients (76,389 in each cohort) after PSM, with a mean age of 72.8 years.
  • SGLT2-Is users demonstrated significantly lower risks of both ischemic stroke (aOR: 0.889) and hemorrhagic stroke (aOR: 0.682) compared to non-users.
  • Secondary outcomes also showed reduced risks for SGLT2-Is users, including all-cause mortality (aOR: 0.615), hospitalizations (aOR: 0.599), AF cardioversion (aOR: 0.846), antiarrhythmic drug initiation (aOR: 0.790), and cardiac arrest (aOR: 0.643).

Conclusions:

  • SGLT2 inhibitor use in patients with atrial fibrillation is linked to reduced risks of stroke.
  • The findings suggest a broader benefit of SGLT2-Is, encompassing lower risks of mortality, hospitalizations, and cardiac arrest.
  • Further prospective research is recommended to confirm these observational findings.
Abstract

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