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. 2024 May;54(5):256-267.
doi: 10.4070/kcj.2023.0234. Epub 2024 Mar 13.

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

Min Kim #  1 , Kyoung Hwa Ha #  2 , Junyoung Lee  1 , Sangshin Park  1 , Kyeong Seok Oh  1 , Dae-Hwan Bae  1 , Ju Hee Lee  1 , Sang Min Kim  1 , Woong Gil Choi  1 , Kyung-Kuk Hwang  1   3 , Dong-Woon Kim  1   3 , Myeong-Chan Cho  1   3 , Dae Jung Kim  4 , Jang-Whan Bae  1   5
Affiliations

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

Min Kim et al. Korean Circ J. 2024 May.

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.

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

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Conflict of interest statement

The authors have no financial conflicts of interest.

Figures

Figure 1
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.
Figure 2
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.
Figure 3
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.
See this image and copyright information in PMC

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