Sodium–glucose cotransporter-2 inhibitors and clinical outcomes in patients with hypertrophic cardiomyopathy and diabetes: a population-based cohort study

AIMS: Hypertrophic cardiomyopathy (HCM) is associated with a significant risk of arrhythmia and heart failure (HF), yet treatment options for patients with HCM have remained limited. We aimed to investigate the relationship between sodium-glucose cotransporter-2 inhibitor (SGLT2i) use and clinical outcomes among patients with concurrent HCM and diabetes in real-world settings. METHODS AND RESULTS: Using the Korean National Health Insurance Service database, we identified patients with a confirmed diagnosis of HCM and prescriptions for antidiabetic drugs from 2018 to 2022. After propensity matching, we compared 2063 patients who received SGLT2i with 2063 patients who did not for clinical outcomes. The primary outcome was a composite of all-cause death and HF hospitalization. Secondary outcomes included individual outcomes of all-cause death, HF hospitalization, sudden cardiac death, and ischaemic stroke. During a median follow-up period of 3.1 years, patients with HCM on SGLT2i had a significantly lower risk of the primary outcome hazard ratio (HR) 0.76, 95% confidence interval (CI) 0.67-0.86. Specifically, SGLT2i use was associated with reduced all-cause mortality (HR 0.56, 95% CI 0.46-0.68) and fewer HF hospitalizations (HR 0.82, 95% CI 0.72-0.94). Additionally, SGLT2i use was linked to a decreased risk of sudden cardiac death (HR 0.50, 95% CI 0.33-0.77) and ischaemic stroke (HR 0.74, 95% CI 0.62-0.88). Subgroup analyses by age, sex, and atrial fibrillation did not reveal any significant interactions. CONCLUSION: The use of SGLT2i was associated with a decreased risk of adverse clinical outcomes among patients with HCM with concurrent diabetes on antidiabetic drugs. LAY SUMMARY: This population-based cohort study examined the association between sodium-glucose cotransporter-2 inhibitors (SGLT2is) and clinical outcomes in patients with hypertrophic cardiomyopathy (HCM) and diabetes.Patients with HCM and diabetes who used SGLT2i had a significantly lower risk of all-cause death and heart failure hospitalization compared with those who did not use SGLT2i.These associations were consistent across various subgroups, including sex, age, atrial fibrillation, and income levels.