Highlights
- •SGLT inhibitors reduced the risk of atrial fibrillation (AF) in our meta-analysis.
- •Risk-reduction in AF remains in diabetics and cardiovascular disease.
- •Risk-reduction in AF is apparent over a longer follow-up duration.
- •Risk-reduction in AF did not extend to patients with heart failure.
- •SGLT inhibitors did not demonstrate an effect on stroke in our meta-analysis.
Abstract
Objectives
Recent clinical trials have shown the potential of sodium glucose cotransporter (SGLT)
2 inhibitors to reduce the risk of atrial fibrillation but not stroke. We conducted
a systematic review and meta-analysis to clarify if SGLT2 or combined SGLT1/2 inhibitors
affect the risk of atrial fibrillation and stroke in patients regardless of diabetic
status.
Materials and methods
Four electronic databases were searched on 21st November 2020 for studies evaluating
outcomes of stroke and atrial fibrillation with SGLT2 or combined SGLT1/2 inhibitors
in both diabetic and non-diabetic patients. Both random and fixed effect, pair-wise
meta-analysis models were used to summarize the results of the studies.
Results
A total of 13 placebo-controlled, randomized-controlled trials were included. Eight
trials comprising 35,702 patients were included in the analysis of atrial fibrillation
outcomes and eight trials comprising 47,910 patients were included in the analysis
of stroke outcomes. Patients on SGLT inhibitors, particularly SGLT2 inhibitors, had
lower odds of atrial fibrillation (Peto odds ratio [95% confidence interval] = 0.76
[0.63–0.92]) compared to placebo. This effect remained significant with a follow-up
duration longer than 1 year, in studies utilizing dapagliflozin, patients with type
2 diabetes mellitus, and patients with cardiovascular disease. No difference was observed
in the odds of atrial fibrillation in patients with baseline heart failure. No effect
was seen on the risk of stroke in patients taking SGLT inhibitors.
Conclusions
SGLT2 inhibitors significantly reduced the odds of atrial fibrillation in diabetic
patients. However, SGLT inhibitors did not significantly affect the risk of stroke.
Key Words
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Article info
Publication history
Published online: October 22, 2021
Accepted:
October 1,
2021
Received in revised form:
September 18,
2021
Received:
July 10,
2021
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2021.106159
Copyright
© 2021 Elsevier Inc. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Response to The Letter to The EditorJournal of Stroke and Cerebrovascular DiseasesVol. 31Issue 3
- Sodium-Glucose Co-Transporter-2 Inhibitors Decrease the Odds for Atrial Fibrillation in Subjects with Heart FailureJournal of Stroke and Cerebrovascular DiseasesVol. 31Issue 3
- PreviewOng et al. have shown in their very informative, recently published meta-analysis that sodium-glucose co-transporter-2 (SGLT-2) inhibitors result in a significant decrease in the odds for atrial fibrillation (AF) regardless of status of diabetes mellitus or cardiovascular disease at baseline.1 However, the authors failed to show that this effect is sustained in subjects with heart failure (HF).1
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