Key result
SGLT2 inhibitors linked to ~20% lower risk of mortality or heart failure hospitalization in HCM.
Why the study?
Although SGLT2 inhibitors have demonstrated clinical benefits in HF across ejection fractions and diabetes status, evidence regarding their effectiveness in patients with HCM remained limited.
Does SGLT2 inhibitor use reduce the composite of all-cause mortality or heart failure hospitalization in patients with hypertrophic cardiomyopathy?
Cohort (n=5,312)
Yes
Does SGLT2 inhibitor use reduce the composite of all-cause mortality or heart failure hospitalization in patients with hypertrophic cardiomyopathy?
In a nationwide cohort of patients with hypertrophic cardiomyopathy, SGLT2 inhibitor use was associated with a significantly lower risk of the composite of all-cause mortality or heart failure hospitalization, driven primarily by reduced heart failure hospitalizations, regardless of diabetes status or obstructive phenotype.
SGLT2 inhibitor use was associated with lower composite risk in hypertrophic cardiomyopathy; extends heart failure benefits but leaves open need for randomized confirmation.
Background Sodium–glucose cotransporter-2 (SGLT2) inhibitors have demonstrated clinical benefits in heart failure (HF) across a broad spectrum of ejection fraction and diabetes status. However, evidence regarding their effectiveness in hypertrophic cardiomyopathy (HCM) remains limited. Purpose We aimed to evaluate the association between SGLT2 inhibitors use and clinical outcomes in a nationwide HCM cohort, including those without diabetes. Methods We conducted a retrospective cohort study using the National Health Insurance Service database. A total of 5,312 patients with HCM (mean age 65 ±14 years; female 39%; diabetes 80%; obstructive type 10%) were identified and matched in a 1:1 ratio by propensity score with 35 baseline variables. The primary outcome was a composite of all-cause mortality or HF hospitalization. Secondary outcomes included all-cause mortality, HF hospitalization, stroke, and myocardial infarction (MI). Results Over a median follow-up of 5.1 years, patients on SGLT2 inhibitors were associated with a lower risk of hospitalizations for HF or mortality compared to those not on SGLT2 inhibitors (HR 0.80, 95% CI 0.71-0.90, P<0.001, Figure). This reduction was primarily driven by a decrease in HF hospitalization (HR 0.79, 95% CI 0.70-0.89; P<0.001). SGLT2 inhibitor use was also associated with a lower risk of stroke (HR 0.51; 95% CI 0.40-0.65; P<0.001), but not of mortality (HR 1.39, 95% CI 0.89-2.18; P=0.15) or MI (HR 0.76. 95% CI 0.57-1.01; P=0.063). The reduction in the primary endpoint was consistent irrespective of diabetic status and obstructive phenotype (P for interaction=0.39 for diabetes; 0.18 for obstructive type). Conclusion In a nationwide cohort of patients with HCM, SGLT2 inhibitor was associated with a lower risk of a composite end-point of mortality and HF hospitalization, with consistent effects across diabetic and non-diabetic patients and across HCM subtypes. These findings suggest potential clinical benefit of SGLT2 inhibitors in a broader HCM population.KM Curves for Outcomes by SGLT2i in HCM
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Shin et al. (2026) conducted a cohort in Hypertrophic cardiomyopathy (n=5,312). Sodium-glucose cotransporter-2 (SGLT2) inhibitors vs. Non-use of SGLT2 inhibitors was evaluated on Composite of all-cause mortality or heart failure hospitalization (HR 0.80, 95% CI 0.71-0.90, p=<0.001). SGLT2 inhibitor use in patients with HCM was associated with a lower risk of all-cause mortality or heart failure hospitalization (HR 0.80; 95% CI 0.71-0.90; P<0.001).
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