Key result
SGLT2i use in patients with atrial fibrillation and type 2 diabetes was associated with a reduced risk of stroke (HR 0.830, P<.001), heart failure, and mortality over 3 years.
Why the study?
SGLT2 inhibitors improve cardiovascular outcomes in type 2 diabetes mellitus, but whether these benefits extend to patients with concomitant atrial fibrillation remains unknown.
Does SGLT2i use reduce cardiovascular events and mortality in patients with concomitant atrial fibrillation and type 2 diabetes mellitus?
Cohort (n=339,792)
Yes
Does SGLT2i use reduce cardiovascular events and mortality in patients with concomitant atrial fibrillation and type 2 diabetes mellitus?
Hazard Ratio: 0.83
p-value: p=<.001
In patients with concomitant atrial fibrillation and type 2 diabetes, SGLT2i use is associated with significantly lower risks of stroke, heart failure, dementia, and all-cause mortality.
SGLT2i use was associated with lower CV risks in AF+T2DM; hypothesis-generating and requires RCTs before practice change.
AIMS: Sodium-glucose co-transporter 2 inhibitors (SGLT2i) enhance cardiovascular outcomes in individuals with type 2 diabetes mellitus (T2DM). Whether such effects also occur in T2DM patients with atrial fibrillation (AF) remains unknown. We aimed to investigate SGLT2i use on cardiovascular outcomes in patients with concomitant AF and T2DM. METHODS: Patients with both AF and T2DM were identified from TriNetX, an international electronic medical record. Participants were divided into 2 groups according to their use of SGLT2i, at a 1:1 distribution through propensity score matching (PSM). The hazard ratio (HR) for clinical outcomes was determined using multivariate Cox hazards regression model. RESULTS: We studied 339 792 patients with AF and T2DM, with 32 945 (9.70%) SGLT2i users. Following PSM, 17 011 patients aged 68.4 ± 7.9 years were included in each group. After a 3-year follow-up, patients treated with SGLT2i showed significantly reduced risks of stroke (adjusted HR: 0.830, P < .001), dementia (adjusted HR: 0.662, P < .001), long-standing persistent AF (adjusted HR: 0.917, P < .001), heart failure (adjusted HR: 0.833, P < .001), and all-cause mortality (adjusted HR: 0.532, P < .001). CONCLUSION: The use of SGLT2i was associated with reduced risks of stroke, dementia, long-standing persistent AF, heart failure, and mortality in patients with both AF and T2DM. SGLT2i may be considered as a potential first-line therapy for this population.
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Hsiao et al. (2025) conducted a cohort in Atrial fibrillation and type 2 diabetes mellitus (n=339,792). Sodium-glucose co-transporter 2 inhibitors (SGLT2i) vs. Non-SGLT2i users was evaluated on stroke (HR 0.830, p=<.001). SGLT2i use in patients with atrial fibrillation and type 2 diabetes was associated with a reduced risk of stroke (HR 0.830, P<.001), heart failure, and mortality over 3 years.
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