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Association of SGLT2 inhibitors with risk of atrial fibrillation and stroke in patients with and without type 2 diabetes: a systemic review and meta-analysis of randomized controlled trials.
Journal of Cardiovascular Pharmacology  (IF3.105),  Pub Date : 2021-11-22, DOI: 10.1097/fjc.0000000000001183
Ru-Jie Zheng, Yue Wang, Jun-Nan Tang, Jie-Ying Duan, Ming-Yue Yuan, Jin-Ying Zhang

Sodium-glucose cotransporter 2 (SGLT2) inhibitors have well-documented effects on reducing hospitalization for heart failure and cardiovascular mortality, while the effect on atrial fibrillation has not been comprehensively investigated. Therefore, we performed a meta-analysis to assess the association between SGLT2 inhibitors and atrial fibrillation risk by systematically searching PubMed, Embase and ClinicalTrials.gov. Two investigators independently identified randomized controlled trials which compared SGLT2 inhibitors with control in patients with type 2 diabetes, heart failure or chronic kidney disease. Primary outcomes were incident atrial fibrillation and stroke. We included 20 randomized trials involving 63604 patients. The SGLT2 inhibitors used were dapagliflozin (7 studies, 28834 patients), canagliflozin (7 studies, 17440 patients), empagliflozin (5 studies, 9082 patients) and ertugliflozin (1 study, 8246 patients). Follow-up ranged from 24 weeks to 202weeks. SGLT2 inhibitors treatment was associated with a significant attenuation in the risk of incident atrial fibrillation (OR=0.82, 95%CI:0.72-0.93, P=0.002) compared with control. No significant difference in stroke between SGLT2 inhibitors and control groups was found (OR=0.99, 95%CI:0.85-1.15, P=0.908). This present meta-analysis indicates that SGLT2 inhibitors are associated with a lower risk of incident atrial fibrillation and don't significantly affect stroke risk for patients with and without type 2 diabetes.