Effect of SGLT2 inhibitors on cardiovascular events in patients with atrial fibrillation: A systematic review and meta‐analysis of randomized controlled trials

Abstract

BackgroundSodium‐glucose cotransporter 2 inhibitors (SGLT2i) is reported to reduce incident atrial fibrillation (AF) in patients with or without diabetes; however, its cardiovascular (CV) benefit for AF patients remains unclear.SSAimsTo investigate the effect of SGLT2i on the incidence of CV events in patients with AF.MethodsSix randomized controlled trials (RCTs) assessing the effects of SGLT2i on CV outcomes in patients with or without AF were included (PROSPERO: CRD 42023431535). The primary endpoint was the composite outcome of heart failure (HF) hospitalization and CV death. Additionally, we assessed the effects of treatment in prespecified subgroups on HF hospitalization, CV death, and all‐cause mortality.ResultsAmong 38,529 participants from all trials, 5018 patients with AF were treated with SGLT2i. The follow‐up period of these trials ranged from 2.3 to 3.3 years. SGLT2i treatment was significantly associated with the risk reduction of primary endpoint in patients with AF (risk ratio [RR] 0.81, 95% confidence interval [CI] 0.74–0.88; p < 0.001), consistent with the finding in the general population (p for interaction = 0.76). SGLT2i was also associated with a consistent reduction in the risk of HF hospitalization in patients with AF (RR 0.76, 95% CI 0.69–0.84; p < 0.001) or not (RR 0.72, 95% CI 0.64–0.80; p < 0.0001), with no statistical difference between them (p for interaction = 0.41). Meta‐regression further revealed no significant association between the prevalence of HF with reduced ejection fraction or diabetes and the effect size of SGLT2i.ConclusionsThe treatment effects of SGLT2i were associated with a lower incidence of CV events, especially HF hospitalization, in patients with AF.

Heart Failure with Mid-Range or Mildly Reduced Ejection Fraction in the Era of Sodium–Glucose Co-Transporter 2 Inhibitors: Do We Now Provide Better Care for the “Middle Child of HF”? Real-World Experience from a Single Clinical Centre

“…Large clinical trials and meta-analyses have investigated the role of SGLT2 inhibition in incident AF, but the results remain controversial [ 28 , 29 ]. A recent study has suggested that the treatment effects of SGLT2i were associated with a lower incidence of HF hospitalization in patients with AF [ 30 ].…”

Update on evidence-based clinical application of sodium-glucose cotransporter inhibitors: Insight to uncommon cardiovascular disease scenarios in diabetes

“…SGLTis were strongly associated with a consistent reduction in the risk of HF hospitalization in patients with AF [RR: 0.76 (95%CI 0.69-0.84); P < 0.001]. Thus, the treatment effects of SGLTis were associated with a lower incidence of cardiovascular events, especially HF hospitalization, in patients with a history of AF[ 37 ].…”

Is it effective SGLT2 inhibitors for every AF patients?

“…We have read with the article "Effect of SGLT2 inhibitors on cardiovascular events in patients with atrial fibrillation: A systematic review and meta-analysis of randomized controlled trials " by Zheng et al 1 The meta-analysis included six randomized controlled studies to evaluate the effects of Sodium-glucose The meta-analysis was derived from randomized clinical trials; however, access to personal data of patients in the included studies was limited. Since the patients could not be evaluated individually, whether the patients had AF and the duration and etiology of AF could not be categorized.…”