Effect of SGLT2 Inhibitors on Atrial Fibrillation in Patients With Type 2 Diabetes With Dilated Cardiomyopathy: A Cohort Study

TL;DR

This study finds that SGLT2 inhibitors may reduce the risk of atrial fibrillation in patients with type 2 diabetes and dilated cardiomyopathy.

Contribution

The study provides new evidence that SGLT2 inhibitors are associated with lower atrial fibrillation incidence in T2DM patients with DCM.

Findings

Patients using SGLT2 inhibitors had a significantly lower AF incidence (7.4%) compared to non-users (18.9%).

The association remained consistent across subgroups like age, gender, and diabetes duration.

Abstract

Dilated cardiomyopathy (DCM) is characterized by left ventricular dilation and systolic dysfunction in the absence of severe hypertension, valvular disease, or coronary artery disease. Patients with DCM have a high risk of atrial fibrillation (AF), especially when combined with Type 2 diabetes mellitus (T2DM). Sodium‐glucose cotransporter 2 inhibitors (SGLT2i) have shown cardioprotective effects in patients with diabetes, suggesting potential benefits in reducing AF incidence.

We retrospectively analyzed clinical data from patients with T2DM diagnosed with DCM treated at the First Affiliated Hospital of Xi’an Jiaotong University between January 2018 and January 2024. Patients were divided into two groups based on their use of SGLT2i. The incidence of AF was compared between these groups using logistic regression models adjusted for potential confounders, including demographic characteristics, comorbidities, and medication history. Additionally, a subgroup analysis was conducted to evaluate the relationship between AF and SGLT2i.

Among 455 enrolled patients, 95 (20.9%) were treated with SGLT2i. The incidence of AF was significantly lower in the SGLT2i group compared with the control group (7/95 [7.4%] vs. 68/360 [18.9%]; OR = 0.308, 95%CI = 0.132–0.735, p = 0.008). Subgroup analyses showed consistent results across various age, gender, hypertension status, and diabetes duration groups, indicating the robustness of the association between SGLT2i use and reduced AF incidence.

Our study suggests that SGLT2i use is associated with a lower incidence of AF in patients with T2DM and DCM. This observed association warrants further investigation in prospective studies to elucidate its nature.

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