Cargando…

Cerebrovascular, Cognitive and Cardiac Benefits of SGLT2 Inhibitors Therapy in Patients with Atrial Fibrillation and Type 2 Diabetes Mellitus: Results from a Global Federated Health Network Analysis

Background: Sodium-glucose co-transporter 2 inhibitors (SGLT2i) are effective anti-diabetic drugs improving cardiovascular outcomes in type 2 diabetes mellitus (T2DM) patients. This study investigated cardiovascular, cerebrovascular and cognitive outcomes of SGLT2i therapy in patients with atrial fi...

Descripción completa

Detalles Bibliográficos
Autores principales: Proietti, Riccardo, Rivera-Caravaca, José Miguel, López-Gálvez, Raquel, Harrison, Stephanie L., Marín, Francisco, Underhill, Paula, Shantsila, Eduard, McDowell, Garry, Vinciguerra, Manlio, Davies, Rhys, Giebel, Clarissa, Lane, Deirdre A., Lip, Gregory Y. H.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10142574/
https://www.ncbi.nlm.nih.gov/pubmed/37109151
http://dx.doi.org/10.3390/jcm12082814
_version_ 1785033645624393728
author Proietti, Riccardo
Rivera-Caravaca, José Miguel
López-Gálvez, Raquel
Harrison, Stephanie L.
Marín, Francisco
Underhill, Paula
Shantsila, Eduard
McDowell, Garry
Vinciguerra, Manlio
Davies, Rhys
Giebel, Clarissa
Lane, Deirdre A.
Lip, Gregory Y. H.
author_facet Proietti, Riccardo
Rivera-Caravaca, José Miguel
López-Gálvez, Raquel
Harrison, Stephanie L.
Marín, Francisco
Underhill, Paula
Shantsila, Eduard
McDowell, Garry
Vinciguerra, Manlio
Davies, Rhys
Giebel, Clarissa
Lane, Deirdre A.
Lip, Gregory Y. H.
author_sort Proietti, Riccardo
collection PubMed
description Background: Sodium-glucose co-transporter 2 inhibitors (SGLT2i) are effective anti-diabetic drugs improving cardiovascular outcomes in type 2 diabetes mellitus (T2DM) patients. This study investigated cardiovascular, cerebrovascular and cognitive outcomes of SGLT2i therapy in patients with atrial fibrillation (AF) and T2DM. Methods: Observational study using TriNetX, a global health research network of anonymised electronic medical records from real-world patients between January 2018 and December 2019. The network includes healthcare organisations globally but predominately in the United States. AF patients (ICD-10-CM code: I48) with T2DM were divided according to SGLT2i use or not, and balanced using propensity score matching (PSM). Patients were followed-up for 3-years. The primary endpoints were ischaemic stroke/transient ischemic attack (TIA), intracranial haemorrhage (ICH), and incident dementia. Secondary endpoints were incident heart failure and mortality. Results: We identified 89,356 AF patients with T2DM of which 5061 (5.7%) were taking a SGLT2i. After PSM, 5049 patients (mean age 66.7 ± 10.6 years; 28.9% female) were included in each group. At 3-years follow-up, the risk of ischaemic stroke/TIA was higher in patients not receiving SGLT2i (HR 1.12, 95% CI 1.01–1.24) and for ICH (HR 1.57, 95% CI 1.25–1.99) and incident dementia (HR 1.66, 95% CI 1.30–2.12). Incident heart failure (HR 1.50, 95% CI 1.34–1.68) and mortality (HR 1.77, 95% CI 1.58–1.99) risks were increased in AF patients not receiving SGLT2i. Conclusions: In our large ‘real world’ analysis of patients with concomitant AF and T2DM, SGLT2i reduced the risk of cerebrovascular events, incident dementia, heart failure and death.
format Online
Article
Text
id pubmed-10142574
institution National Center for Biotechnology Information
language English
publishDate 2023
publisher MDPI
record_format MEDLINE/PubMed
spelling pubmed-101425742023-04-29 Cerebrovascular, Cognitive and Cardiac Benefits of SGLT2 Inhibitors Therapy in Patients with Atrial Fibrillation and Type 2 Diabetes Mellitus: Results from a Global Federated Health Network Analysis Proietti, Riccardo Rivera-Caravaca, José Miguel López-Gálvez, Raquel Harrison, Stephanie L. Marín, Francisco Underhill, Paula Shantsila, Eduard McDowell, Garry Vinciguerra, Manlio Davies, Rhys Giebel, Clarissa Lane, Deirdre A. Lip, Gregory Y. H. J Clin Med Article Background: Sodium-glucose co-transporter 2 inhibitors (SGLT2i) are effective anti-diabetic drugs improving cardiovascular outcomes in type 2 diabetes mellitus (T2DM) patients. This study investigated cardiovascular, cerebrovascular and cognitive outcomes of SGLT2i therapy in patients with atrial fibrillation (AF) and T2DM. Methods: Observational study using TriNetX, a global health research network of anonymised electronic medical records from real-world patients between January 2018 and December 2019. The network includes healthcare organisations globally but predominately in the United States. AF patients (ICD-10-CM code: I48) with T2DM were divided according to SGLT2i use or not, and balanced using propensity score matching (PSM). Patients were followed-up for 3-years. The primary endpoints were ischaemic stroke/transient ischemic attack (TIA), intracranial haemorrhage (ICH), and incident dementia. Secondary endpoints were incident heart failure and mortality. Results: We identified 89,356 AF patients with T2DM of which 5061 (5.7%) were taking a SGLT2i. After PSM, 5049 patients (mean age 66.7 ± 10.6 years; 28.9% female) were included in each group. At 3-years follow-up, the risk of ischaemic stroke/TIA was higher in patients not receiving SGLT2i (HR 1.12, 95% CI 1.01–1.24) and for ICH (HR 1.57, 95% CI 1.25–1.99) and incident dementia (HR 1.66, 95% CI 1.30–2.12). Incident heart failure (HR 1.50, 95% CI 1.34–1.68) and mortality (HR 1.77, 95% CI 1.58–1.99) risks were increased in AF patients not receiving SGLT2i. Conclusions: In our large ‘real world’ analysis of patients with concomitant AF and T2DM, SGLT2i reduced the risk of cerebrovascular events, incident dementia, heart failure and death. MDPI 2023-04-11 /pmc/articles/PMC10142574/ /pubmed/37109151 http://dx.doi.org/10.3390/jcm12082814 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Proietti, Riccardo
Rivera-Caravaca, José Miguel
López-Gálvez, Raquel
Harrison, Stephanie L.
Marín, Francisco
Underhill, Paula
Shantsila, Eduard
McDowell, Garry
Vinciguerra, Manlio
Davies, Rhys
Giebel, Clarissa
Lane, Deirdre A.
Lip, Gregory Y. H.
Cerebrovascular, Cognitive and Cardiac Benefits of SGLT2 Inhibitors Therapy in Patients with Atrial Fibrillation and Type 2 Diabetes Mellitus: Results from a Global Federated Health Network Analysis
title Cerebrovascular, Cognitive and Cardiac Benefits of SGLT2 Inhibitors Therapy in Patients with Atrial Fibrillation and Type 2 Diabetes Mellitus: Results from a Global Federated Health Network Analysis
title_full Cerebrovascular, Cognitive and Cardiac Benefits of SGLT2 Inhibitors Therapy in Patients with Atrial Fibrillation and Type 2 Diabetes Mellitus: Results from a Global Federated Health Network Analysis
title_fullStr Cerebrovascular, Cognitive and Cardiac Benefits of SGLT2 Inhibitors Therapy in Patients with Atrial Fibrillation and Type 2 Diabetes Mellitus: Results from a Global Federated Health Network Analysis
title_full_unstemmed Cerebrovascular, Cognitive and Cardiac Benefits of SGLT2 Inhibitors Therapy in Patients with Atrial Fibrillation and Type 2 Diabetes Mellitus: Results from a Global Federated Health Network Analysis
title_short Cerebrovascular, Cognitive and Cardiac Benefits of SGLT2 Inhibitors Therapy in Patients with Atrial Fibrillation and Type 2 Diabetes Mellitus: Results from a Global Federated Health Network Analysis
title_sort cerebrovascular, cognitive and cardiac benefits of sglt2 inhibitors therapy in patients with atrial fibrillation and type 2 diabetes mellitus: results from a global federated health network analysis
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10142574/
https://www.ncbi.nlm.nih.gov/pubmed/37109151
http://dx.doi.org/10.3390/jcm12082814
work_keys_str_mv AT proiettiriccardo cerebrovascularcognitiveandcardiacbenefitsofsglt2inhibitorstherapyinpatientswithatrialfibrillationandtype2diabetesmellitusresultsfromaglobalfederatedhealthnetworkanalysis
AT riveracaravacajosemiguel cerebrovascularcognitiveandcardiacbenefitsofsglt2inhibitorstherapyinpatientswithatrialfibrillationandtype2diabetesmellitusresultsfromaglobalfederatedhealthnetworkanalysis
AT lopezgalvezraquel cerebrovascularcognitiveandcardiacbenefitsofsglt2inhibitorstherapyinpatientswithatrialfibrillationandtype2diabetesmellitusresultsfromaglobalfederatedhealthnetworkanalysis
AT harrisonstephaniel cerebrovascularcognitiveandcardiacbenefitsofsglt2inhibitorstherapyinpatientswithatrialfibrillationandtype2diabetesmellitusresultsfromaglobalfederatedhealthnetworkanalysis
AT marinfrancisco cerebrovascularcognitiveandcardiacbenefitsofsglt2inhibitorstherapyinpatientswithatrialfibrillationandtype2diabetesmellitusresultsfromaglobalfederatedhealthnetworkanalysis
AT underhillpaula cerebrovascularcognitiveandcardiacbenefitsofsglt2inhibitorstherapyinpatientswithatrialfibrillationandtype2diabetesmellitusresultsfromaglobalfederatedhealthnetworkanalysis
AT shantsilaeduard cerebrovascularcognitiveandcardiacbenefitsofsglt2inhibitorstherapyinpatientswithatrialfibrillationandtype2diabetesmellitusresultsfromaglobalfederatedhealthnetworkanalysis
AT mcdowellgarry cerebrovascularcognitiveandcardiacbenefitsofsglt2inhibitorstherapyinpatientswithatrialfibrillationandtype2diabetesmellitusresultsfromaglobalfederatedhealthnetworkanalysis
AT vinciguerramanlio cerebrovascularcognitiveandcardiacbenefitsofsglt2inhibitorstherapyinpatientswithatrialfibrillationandtype2diabetesmellitusresultsfromaglobalfederatedhealthnetworkanalysis
AT daviesrhys cerebrovascularcognitiveandcardiacbenefitsofsglt2inhibitorstherapyinpatientswithatrialfibrillationandtype2diabetesmellitusresultsfromaglobalfederatedhealthnetworkanalysis
AT giebelclarissa cerebrovascularcognitiveandcardiacbenefitsofsglt2inhibitorstherapyinpatientswithatrialfibrillationandtype2diabetesmellitusresultsfromaglobalfederatedhealthnetworkanalysis
AT lanedeirdrea cerebrovascularcognitiveandcardiacbenefitsofsglt2inhibitorstherapyinpatientswithatrialfibrillationandtype2diabetesmellitusresultsfromaglobalfederatedhealthnetworkanalysis
AT lipgregoryyh cerebrovascularcognitiveandcardiacbenefitsofsglt2inhibitorstherapyinpatientswithatrialfibrillationandtype2diabetesmellitusresultsfromaglobalfederatedhealthnetworkanalysis