Korean Circ J.  2024 May;54(5):256-267. 10.4070/kcj.2023.0234.

Lower Atrial Fibrillation Risk With Sodium-Glucose Cotransporter 2 Inhibitors Than With Dipeptidyl Peptidase-4 Inhibitors in Individuals With Type 2 Diabetes: A Nationwide Cohort Study

• Kim M
• Ha KH
• Lee J
• Park S
• Oh KS
• Bae DH
• Lee JH
• Kim SM
• Choi WG
• Hwang KK
• Kim DW
• Cho MC
• Kim DJ
• Bae JW

• KMID: 2556522
• DOI: http://doi.org/10.4070/kcj.2023.0234

Abstract

Background and Objectives
Accumulating evidence shows that sodium-glucose cotransporter 2 inhibitors (SGLT2is) reduce adverse cardiovascular outcomes. However, whether SGLT2i, compared with other antidiabetic drugs, reduce the new development of atrial fibrillation (AF) is unclear. In this study, we compared SGLT2i with dipeptidyl peptidase-4 inhibitors (DPP-4is) in terms of reduction in the risk of AF in individuals with type 2 diabetes.
Methods
We included 42,786 propensity score-matched pairs of SGLT2i and DPP-4i users without previous AF diagnosis using the Korean National Health Insurance Service database between May 1, 2016, and December 31, 2018.
Results
During a median follow-up of 1.3 years, SGLT2i users had a lower incidence of AF than DPP-4i users (1.95 vs. 2.65 per 1,000 person-years; hazard ratio [HR], 0.73; 95% confidence interval [CI], 0.55–0.97; p=0.028]). In individuals without heart failure, SGLT2i users was associated with a decreased risk of AF incidence (HR, 0.70; 95% CI, 0.52–0.94; p=0.019) compared to DPP-4i users. However, individuals with heart failure, SGLT2i users was not significantly associated with a change in risk (HR, 1.04; 95% CI, 0.44–2.44; p=0.936).
Conclusions
In this nationwide cohort study of individuals with type 2 diabetes, treatment with SGLT2i was associated with a lower risk of AF compared with treatment with DPP-4i.

Keyword

Atrial fibrillation; Diabetes mellitus; Sodium-glucose transporter 2 inhibitors; Dipeptidyl-peptidase IV inhibitors

Figure

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  Figure 1 Flowchart of participant inclusion.AAD = antiarrhythmic drug; AF = atrial fibrillation; DPP-4i = dipeptidyl peptidase-4 inhibitor; ESKD = end-stage kidney disease; SGLT2i = sodium-glucose cotransporter 2 inhibitor.

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  Figure 2 Cumulative incidence curves of atrial fibrillation in the propensity score-matched cohort.DPP-4i = dipeptidyl peptidase-4 inhibitor; SGLT2i = sodium-glucose cotransporter 2 inhibitor.

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  Figure 3 Subgroup analyses of the risk of atrial fibrillation according to age, sex, comorbidities, and estimated thromboembolic risk. CVD is defined as heart failure, ischemic stroke, transient ischemic attack, hemorrhagic stroke, acute coronary syndrome, chronic coronary syndrome, and peripheral disease (listed in Table 1).CI = confidence interval; CVD = cardiovascular disease; DPP-4i = dipeptidyl peptidase-4 inhibitor; HR = hazard ratio; SGLT2i = sodium-glucose cotransporter 2 inhibitor.

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