IMR Press / RCM / Volume 23 / Issue 9 / DOI: 10.31083/j.rcm2309303
Open Access Original Research
Effects of Sodium-Glucose Cotransporter-2 Inhibitors and Thiazolidinedione on New-Onset Atrial Fibrillation Risk to Patients with Type 2 Diabetes
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1 Division of Cardiology, Department of Internal Medicine, Chung-Ang University, Gwang-Myong Hospital, 14353 Seoul, Republic of Korea
2 Division of Cardiology, Department of Internal Medicine, Chonnam National University, 61469 Gwangju, Republic of Korea
3 Division of Endocrinology, Department of Internal Medicine, Dongguk University Ilsan Hospital, 10326 Goyang, Republic of Korea
4 Data Science Team, Hanmi Pharm. Co. Ltd, 05545 Seoul, Republic of Korea
*Correspondence: kyoung-ah.kim@dumc.or.kr (Kyoung-Ah Kim)
Academic Editors: Dominique Cadilhac and Muideen Olaiya
Rev. Cardiovasc. Med. 2022, 23(9), 303; https://doi.org/10.31083/j.rcm2309303
Submitted: 24 June 2022 | Revised: 10 August 2022 | Accepted: 15 August 2022 | Published: 9 September 2022
(This article belongs to the Special Issue Cardiovascular Health and Cerebrovascular Disorders)
Copyright: © 2022 The Author(s). Published by IMR Press.
This is an open access article under the CC BY 4.0 license.
Abstract

Background and Objectives: Type 2 diabetes (T2D) is an independent risk factor for the development of atrial fibrillation (AF). Sodium-glucose cotransporter-2 inhibitors (SGLT-2i) have recently been shown to decrease the incidence of AF through several mechanisms, including the reduction of atrial dilatation via diuresis and the lowering of body weight. In observational studies of diabetic patients, the use of thiazolidinedione (TZD) was found to have a protective effect on new-onset AF. In this study, we aimed to compare the effect of SGLT-2i and TZD on the risk of AF in patients with T2D. Methods: We enrolled 69,122 patients newly prescribed SGLT-2i and 94,262 patients prescribed TZD from January 2014 to December 2018, using the Korean National Health Insurance Service database. We compared new-onset AF events (hospitalizations and outpatient events) in SGLT-2i and TZD groups after having taken medication for greater than 90 days. Results: During a mean follow-up of 1.8 years, 397 (0.72%) new-onset AF events occurred in the SGLT-2i group and 432 (0.79%) events in the TZD group following propensity score matching (each group n = 54,993). The hazard ratio (HR) of AF was 0.918 (95% confidence interval: 0.783–1.076, p = 0.29) in SGLT-2i-treated patients compared with TZD-treated patients. Conclusions: In this study, the risk of new-onset AF is comparable in patients treated with SGLT-2i and TZD in T2D. Either SGLT-2i or TZD would be a reasonable choice for T2D patients who are at risk for AF.

Keywords
sodium-glucose cotransporter-2 inhibitors
atrial fibrillation
thiazolidinediones
diabetes mellitus type 2
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