Abstract 14106: The Efficacy of Sodium Glucose Co-transporter 2 Inhibitors in Atrial Fibrillation: A Systematic Review and Meta-analysis of Randomized Controlled Trials
Asad, ZUA; Jafry, A; Akhtar, K; Wang, A; Khan, MS; Khan, SU; Chung, MK; Piccini, JP; Stavrakis, S
Published in: Circulation
Atrial Fibrillation (AF) is common in patients with Type 2 diabetes mellitus and it is associated with adverse outcomes. The impact of SGLT-2 inhibitors on incident AF and cardiovascular outcomes is unknown.
A systematic review of Medline, EMBASE and other online sources was conducted on 04/22/2020. All randomized controlled trials (RCTs) comparing SGLT-2 to placebo reporting incident AF were included. Mantel Haenszel random effects modeling was used to estimate risk ratios (RR) and I
statistics were used to assess heterogeneity.
A total of 33 RCTs (n=65,505 patients) were included. SGTL-2 inhibitor (canagliflozin, dapagliflozin, empagliflozin, ertugliflozin) use was not associated with statistically significant benefit in preventing AF [RR 0.91 (0.80-1.04)] (Figure-1). Subgroup analysis showed that only Dapagliflozin had a statistically significant effect in preventing AF [RR 0.79 (0.66-0.93), p=0.006, I
=0%] (p<0.05 compared to others). SGLT-2 inhibitors were associated with a 25% relative risk reduction in the composite outcome of CV mortality or CV hospitalization in patients with history of AF [RR 0.75 (0.62-0.90)] and 27% in patients with no history of AF [RR 0.73 (0.66-0.81)].
SGLT-2 inhibitors prevent adverse cardiovascular outcomes regardless of baseline AF status. The protective effects of SGLT-2 inhibitors in preventing AF appear limited to Dapagliflozin.