Benefits of SGLT2 inhibitors may extend beyond HF-associated outcomes

Diabetic patients demonstrated to benefit from sodium-glucose cotransporter-2 (SGLT2) inhibitors beyond the scope of heart failure (HF)-associated outcomes. The risk of HF, overall mortality, cardiac arrest, atrial fibrillation (AF), and ischaemic stroke were reduced in diabetic patients on SGLT2 inhibitors compared with diabetic patients who were not on SGLT2 inhibitors.

The use of SGLT2 inhibitors has been associated with improved outcomes in patients with prevalent HF, regardless of the diabetic status of the patient [1]. Moreover, SGLT2 inhibitors have been shown to exert their effect through various cardiometabolic and cardio-renal pathways [2]. The current study aimed to assess the impact of SGLT2 inhibitors on the risk of HF and cardiovascular events in patients with diabetes [3]. Data from the TriNetX database was used to compare 115,749 patients with diabetes who were treated with SGLT2 inhibitors with 11,749 matched participants who were not treated with SGLT2 inhibitors. The primary outcome was the rate of HF incident. Dr Ameenathul Fawzy (Liverpool Heart and Chest Hospital, UK) presented the results.

After 2 years of follow-up, the rate of HF was significantly lower in patients who were treated with SGLT2 inhibitors (HR 0.67; 95% CI 0.65–0.70). Most secondary outcomes displayed a significant benefit of SGLT2 inhibitors: all-cause mortality (HR 0.62), cardiac arrest (HR 0.62), composite arterial and venous thrombotic events (HR 0.93), AF (HR 0.78), ventricular tachycardia/ventricular fibrillation/cardiac arrest (HR 0.74), and ischaemic stroke (HR 0.93). The number of ventricular tachycardia/ventricular fibrillation events was the only secondary outcome that did not significantly favour patients who were treated with SGLT2 inhibitors over those who were not (HR 0.94; 95% CI 0.88–1.01; see Figure).

Figure: Incident HF and other outcomes in diabetic patients with or without SGLT2 inhibitors [3]



 

 

 

 

 

 

 

 

 

“These outcomes show that the benefits of SGLT2 inhibitors appear to extend beyond HF-associated outcomes,” argued Dr Fawzy. “Although we observed that SGLT2 inhibitors mediate their effects through multiple pathways, further research is required to evaluate the effects of these agents on specific patient populations, such as post-MI patients.”

1. Tsampasian V, et al. Cardiol Res Pract. 2021:9927533.
2. Cowie MR, et al. Nat Rev Cardiol.2020;17:761–772.
3. Fawzy AM, et al. Incident arrhythmias, heart failure and cardiovascular outcomes with SGLT-2 inhibitor use in diabetic patients: Insights from a global federated electronic medical record database. News on atrial fibrillation, EHRA 2022, 3–5 April, Copenhagen, Denmark.

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Posted on 1 June 202217 May 2024