Korean Circulation Journal

The Korean Society of Cardiology (대한심장학회)
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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 (Department of Cardiology, Chungbuk National University Hospital) ;
  • Kyoung Hwa Ha (Department of Endocrinology and Metabolism, Ajou University School of Medicine) ;
  • Junyoung Lee (Department of Cardiology, Chungbuk National University Hospital) ;
  • Sangshin Park (Department of Cardiology, Chungbuk National University Hospital) ;
  • Kyeong Seok Oh (Department of Cardiology, Chungbuk National University Hospital) ;
  • Dae-Hwan Bae (Department of Cardiology, Chungbuk National University Hospital) ;
  • Ju Hee Lee (Department of Cardiology, Chungbuk National University Hospital) ;
  • Sang Min Kim (Department of Cardiology, Chungbuk National University Hospital) ;
  • Woong Gil Choi (Department of Cardiology, Chungbuk National University Hospital) ;
  • Kyung-Kuk Hwang (Department of Cardiology, Chungbuk National University Hospital) ;
  • Dong-Woon Kim (Department of Cardiology, Chungbuk National University Hospital) ;
  • Myeong-Chan Cho (Department of Cardiology, Chungbuk National University Hospital) ;
  • Dae Jung Kim (Department of Endocrinology and Metabolism, Ajou University School of Medicine) ;
  • Jang-Whan Bae (Department of Cardiology, Chungbuk National University Hospital)
  • Received : 2023.08.21
  • Accepted : 2024.02.13
  • Published : 2024.05.01
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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

Acknowledgement

This work was supported by a 2022 research grant from Chungbuk National University Hospital.

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