Incident heart failure, arrhythmias and cardiovascular outcomes with sodium‐glucose cotransporter 2 (SGLT2) inhibitor use in patients with diabetes: Insights from a global federated electronic medical record database

• Published in: Diabetes, obesity & metabolism obesity & metabolism, 2023-02, Vol.25 (2), p.602-610
• Main Authors: Fawzy, Ameenathul Mazaya, Rivera‐Caravaca, José Miguel, Underhill, Paula, Fauchier, Laurent, Lip, Gregory Y. H.
• Format: Article
• Language: English
• Subjects: Arrhythmia; Arrhythmias, Cardiac - epidemiology; Brain Ischemia; Cardiac arrhythmia; cardiovascular outcomes; Congestive heart failure; Diabetes; Diabetes mellitus; Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - drug therapy; Diabetes Mellitus, Type 2 - epidemiology; diabetic; Electronic Health Records; Electronic medical records; Fibrillation; Glucose; Heart Arrest - chemically induced; Heart Arrest - complications; Heart failure; Heart Failure - complications; Heart Failure - epidemiology; Humans; incident heart failure; Ischemia; Ischemic Attack, Transient - chemically induced; Ischemic Attack, Transient - complications; Ischemic Stroke - chemically induced; Ischemic Stroke - complications; Medical prognosis; Medical records; Mortality; Original; prognosis; SGLT2 inhibitors; Sodium; Sodium-glucose cotransporter; Sodium-Glucose Transporter 2 Inhibitors - adverse effects; Stroke; Stroke - chemically induced; Stroke - epidemiology; Stroke - prevention & control; Tachycardia; Transient ischemic attack; Ventricle
• ISSN: 1462-8902; 1463-1326
• DOI: 10.1111/dom.14854

Aim To investigate the impact of sodium‐glucose cotransporter 2 (SGLT2) inhibitors on the risk of incident heart failure and adverse cardiovascular outcomes. Methods All patients with diabetes who were registered between January 2018 and December 2019 were identified from a federated electronic medical record database (TriNetX) and followed up for 2 years. A 1:1 propensity‐score matching (PSM) analysis was performed to balance the SGLT2 inhibitor and non‐SGLT2 inhibitor cohorts. The primary outcome was incident heart failure. Secondary outcomes included all‐cause mortality, cardiac arrest, ventricular tachycardia/ventricular fibrillation (VT/VF), incident atrial fibrillation (AF), ischaemic stroke/transient ischaemic attack (TIA), composite of arterial and venous thrombotic events, and composite of incident VT/VF and cardiac arrest. Results A total of 131 189 and 2 692 985 patients were treated with and without SGLT2 inhibitors, respectively. After PSM, 131 188 patients remained in each group. The risk of incident heart failure was significantly lower in the SGLT2 inhibitor cohort compared to the non‐SGLT2 inhibitor cohort (hazard ratio [HR] 0.70, 95% confidence interval [CI] 0.68‐0.73). SGLT2 inhibitor use was also associated with a significantly lower risk of all‐cause mortality (HR 0.61, 95% CI 0.58‐0.64), cardiac arrest (HR 0.70, 95% CI 0.63‐0.78), incident AF (HR 0.81, 95% CI 0.76‐0.84), ischaemic stroke/TIA (HR 0.90, 95% CI 0.88‐0.93), composite of arterial and venous thrombotic events (HR 0.90, 95% CI 0.88‐0.92), and composite of incident VT/VF and cardiac arrest (HR 0.76, 95% CI 0.71‐0.81). There were no significant differences for VT/VF (HR 0.94, 95% CI 0.88‐1.00). Conclusion Use of SGLT2 inhibitors was associated with a significant reduction in the risk of incident heart failure and adverse cardiovascular outcomes but not ventricular arrhythmias.