Key result
SGLT2 inhibitors significantly reduced the occurrence of serious adverse events of atrial fibrillation and atrial flutter compared to placebo (RR 0.83).
Why the study?
SGLT2 inhibitors have been reported to prevent atrial fibrillation and atrial flutter in some studies but not others.
Does SGLT2i use reduce the risk of atrial fibrillation and atrial flutter in adult patients compared to placebo?
Meta-Analysis (n=66,685)
Does SGLT2i use reduce the risk of atrial fibrillation and atrial flutter in adult patients compared to placebo?
Relative Risk: 0.83 (95% CI 0.71–0.96)
Absolute Event Rate: 0.96% vs 1.19%
p-value: p=0.01
SGLT2 inhibitors, particularly dapagliflozin, are associated with a significantly lower risk of incident atrial fibrillation and atrial flutter compared to placebo.
SGLT2i may reduce AF/AFL events; confirms benefit in 33 placebo-controlled RCTs.
Background Hyperglycemia is associated with an increased risk of developing atrial fibrillation (AF) and atrial flutter (AFL). Sodium-glucose transporter 2 inhibitors (SGLT2i) have been reported to prevent AF/AFL in some studies, but not others. Therefore, a meta-analysis was performed to investigate whether SGLT2i use is associated with lower risks of AF/AFL. Methods PubMed, Scopus, Web of Science, Cochrane library databases were searched for randomized placebo-controlled trials comparing SGLT2i and placebo. Results A total of 33 trials involving 66,685 patients were included. The serious adverse events (SAEs) of AF/AFL occurrence were significantly lower in the SGLT2i group than the placebo group (0.96% vs. 1.19%; RR 0.83; 95% CI 0.71–0.96; P = 0.01; I 2 25.5%). Similarly, the SAEs of AF occurrence was significantly lower in the SGLT2i group (0.82% vs. 1.06%; RR 0.81; 95% CI 0.69–0.95; P = 0.01; I 2 10.2%). The subgroup analysis showed that the reduction in AF/AFL was significant only for dapagliflozin (1.02% vs. 1.49%; RR 0.73; 95% CI 0.59–0.89; P = 0.002; I2 0%), but not for canagliflozin (1.00% vs 1.08%; RR 0.83; 95% CI 0.62–1.12; P = 0.23; I 2 0%), empagliflozin (0.88% vs 0.70%; RR 1.20; 95% CI 0.76–1.90; P = 0.43; I 2 0%), ertugliflozin (1.01% vs 0.96%; RR 1.08; 95% CI 0.66–1.75; P = 0.76; I 2 0%), and sotagliflozin (0.16% vs 0.10%; RR 1.09; 95% CI 0.13–8.86; P = 0.93; I 2 0%). Conclusions SGLT2i use is associated with a 19.33% lower SAEs of AF/AFL compared with the placebo. Dapagliflozin users had the lowest SAEs of AF/AFL incidence. Further studies are needed to determine whether canagliflozin, empagliflozin, ertugliflozin, and sotagliflozin similarly exert protective effects against AF/AFL development.
No takes yet. Share an insight, caveat, or question.
Li et al. (2021) conducted a meta-analysis in Atrial fibrillation and atrial flutter (n=66,685). Sodium-glucose transporter 2 inhibitors (SGLT2i) vs. Placebo was evaluated on Serious adverse events (SAEs) of AF/AFL occurrence (RR 0.83, 95% CI 0.71-0.96, p=0.01). SGLT2 inhibitors significantly reduced the occurrence of serious adverse events of atrial fibrillation and atrial flutter compared to placebo (RR 0.83).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: