Funding Acknowledgements Type of funding sources: None. Background Hyperkalemia is a common complication and increases the risk of cardiac arrhythmias and mortality in patients with type 2 diabetes (T2DM), especially in those with diabetic nephropathy. We investigated the risk of hyperkalemia in patients initiated on SGLT2 inhibitors versus DPP-4 inhibitors among patients with T2DM. Methods This study included patients with T2DM who initiated on SGLT2 inhibitors or DPP-4 inhibitors between January 01, 2015 and December 31, 2019 from a territory-wide clinical registry in Hong Kong (Clinical Data Analysis and Reporting System [CDARS]). A multivariable cox proportional hazards analysis, adjusting for key confounders, was used to compare the risk of central laboratory-determined hyperkalemia (serum potassium ≥6.0mmol/L) and hypokalemia (serum potassium <3.5mmol/L), respectively, between SGLT2 inhibitors and DPP-4 inhibitors. Results 10193 new users of SGLT2 inhibitors were matched to 17305 new users of DPP-4 inhibitors. During the 2-year follow-up, there were 104 hyperkalemia events (incident rate [IR] = 5.17 per 1000 person-years) among SGLT2 inhibitors and 306 events (IR = 9.09 per 1000 person-years) among DPP-4 inhibitors, of which SGLT2 inhibitors were associated with a lower risk of incident hyperkalemia (Adjusted HR: 0.66 [95%CI 0.53-0.83], p<0.001), compared to DPP-4 inhibitors. The incident hypokalemia was similar between SGLT2 inhibitors and DPP-4 inhibitors (Adjusted HR: 0.91 [95%CI 0.81-1.03], P=0.13). Conclusion SGLT2 inhibitors reduced incident hyperkalemia, but without increasing incident hypokalemia compared to DPP-4 inhibitors.
Funding Acknowledgements Type of funding sources: Public hospital(s). Main funding source(s): Sanming Project of Medicine in Shenzhen, China; HKU-SZH Fund for Shenzhen Key Medical Discipline Background Prosthetic valve endocarditis (PVE) is a rare but serious complication following valvular heart surgery for which preventive strategies remain unknown. Recent epidemiological evidence suggests that statins may reduce the risk of infections and infection-related complications. Purpose We aim to assess the association between statin use and the risk of prosthetic valve endocarditis in patients undergoing valvular heart surgery. Methods In all patients undergoing valvular heart surgery in Hong Kong between 2010 and 2021, statin use was ascertained by ≥14-day consecutive filled prescriptions after surgery. Stepwise Poisson regression was applied to identify predictors of PVE. Baseline characteristics between statin nonusers (N = 1400) with statin users (N = 976) were balanced using the inverse probability of treatment weighting. Cox proportional-hazard models with competing risk regression were further performed to estimate the risk of PVE and cardiovascular mortality associated with statin use. Results Our study included 2376 patients; the mean age was 57.8±14.2 years, and 54.4% were males. Over a median follow-up of 5.5 years (interquartile range 2.8-8.6), PVE occurred in 93 patients (6.75 [95% CI 5.51-8.26] PVE events per 1000 person-years). PVE was associated with New York Heart Association Class (Relative Risk [RR] 1.22, 95% Confidence Interval [CI] 1.01-1.45; P = 0.035), prior infective endocarditis (RR 8.64, 95% CI 5.58-13.19; P < 0.001), and aortic valve replacement (RR 1.67, 95% CI 1.11-2.53; P = 0.014). Compared with non-use, statin use was associated with a 47% lower risk of PVE incidence (multivariable-adjusted subdistribution hazard ratio [SHR] 0.53, 95% CI 0.33-0.83; P = 0.006) (Figure 1). This inverse association with the risk of PVE was duration dependent, with an adjusted SHR of 0.60 (95% CI 0.47-0.73; P < 0.001) per year of statin use. Results were consistent across subgroups of sex (male vs female), the number of valvular procedures (single vs multiple), and prosthesis type (mechanical vs biological), but not in groups aged ≤60 years or with prior infective endocarditis (Figure 2). Statin use was associated with a 45% decreased risk of cardiovascular death (SHR 0.55, 95% CI 0.36-0.84; P = 0.006). Conclusions In patients undergoing valvular surgery, post-operative statin use is associated with a lower risk of PVE. These results provide new avenues for preventing PVE and hence valve failure.
Objective Severe aortic stenosis (AS) is the primary valvular heart disease, treatable only by aortic valve replacement (AVR). The prognostic value of pre-operative left atrial (LA) function on post-AVR clinical outcomes is uncertain. The study aims to evaluate the prognostic value of pre-operative peak atrial longitudinal strain (PALS) as a surrogate of LA function on post AVR all-cause mortality and heart failure hospitalisation. Methods Patients aged 18 years old or above with severe AS were recruited and assessed using speckle-tracking echocardiography pre-operatively. Severe AS was defined according to 2014 AHA/ACC Guideline for the Management of Patients with Valvular Heart Disease. PALS was measured. Based on the median value of PALS, patients were stratified into PALS <15.94% and PALS >15.94%. Patients with underlying pre-operative atrial fibrillation, other moderate to severe valvular heart diseases and cancers were excluded. Patients were followed up until death, heart failure hospitalisation or end of the study. The primary outcome is a composite endpoint of all-cause mortality and heart failure hospitalisation. The association of PALS with the composite endpoint was evaluated by Cox Proportional Hazards analysis. Results A total of 128 patients (mean age 65.32±9.42 years, 56.3% male) were prospectively analyzed. Patients were followed up for a mean period of 3.9±2.4 years. A total of 65 of 128 patients (50.8%) belonged to PALS<15.94%. During the study period, 23 patients developed the adverse events. A lower pre-operative PALS, both as a continuous or a categorical variable, were associated with a higher unadjusted risk of adverse events (Continuous; HR, 0.93; 95% CI 0.88–0.98; p=0.011; PALS <15.94%; HR, 4.94; 95% CI, 1.67–14.58; p=0.004). Conclusion The study demonstrated a lower pre-operative PALS is associated with all-cause mortality and heart failure admission in patients with severe AS undergoing AVR. Evaluation of LA function by assessing speckle tracking derived PALS may aid in prognostication for patients undergoing AVR. Funding Acknowledgement Type of funding sources: None.
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