SGLT2 inhibitors reduce risk of atrial fibrillation, sudden cardiac death in patients with Type 2 diabetes

SGLT2 inhibitors are associated with a significant reduction in atrial arrhythmias and sudden cardiac death in patients with Type 2 diabetes (T2D), according to new findings published in Heart Rhythm.

The authors performed a meta-analysis of 34 different studies that covered more than 63,000 patients in total. All studies had either a randomized or double-blind design, utilized a control group and focused on adult patients diagnosed with T2D, heart failure or both. Two independent investigators examined each trial to confirm it could be included. Exclusions occurred if a study did not have arrhythmia-related endpoints or if it overlapped with another study from the same authors or the same institution.

Specific medications included in the studies were canagliflozin, dapagliflozin, empagliflozin and ertugliflozin.

Reviewing the healthy helping of data, the authors found that the cumulative incidence of atrial arrhythmias (3.6 per 10,000 patient-years), ventricular arrhythmias (1.4) and sudden cardiac deaths (2.5) were all quite low.

Overall, SGLT2 inhibitors were associated with a 19% reduction in a patient’s risk of atrial arrythmias and a 28% relative reduction in a patient’s risk of sudden cardiac death. Atrial arrhythmias, defined as either atrial fibrillation or atrial flutter, were reported in 32 of the 34 studies the authors evaluated. Sudden cardiac death was separated into three different components: sudden cardiac death, sudden death and cardiac arrest. It was reported in 19 of the 34 studies overall, and that 28% reduction was for sudden cardiac death specifically and not only sudden death or only cardiac arrest.

“More specifically designed studies are needed to confirm these benefits in patients with T2D and, in particular, heart failure,” wrote lead author Gilson C. Fernandes, MD, a cardiologist at the University of Miami Miller School of Medicine, and colleagues. “Prospective trials are warranted to confirm the antiarrhythmic effect of SGLT2i and to investigate whether this is related to improvement of heart failure and a class or drug-specific effect.”

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