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Stachteas P, Nasoufidou A, Karagiannidis E, Patoulias D, Karakasis P, Alexiou S, Samaras A, Zormpas G, Stavropoulos G, Tsalikakis D, Kassimis G, Papadopoulos C, Fragakis N. The Role of Sodium Glucose Co-Transporter 2 Inhibitors in Atrial Fibrillation: A Comprehensive Review. J Clin Med 2024; 13:5408. [PMID: 39336895 PMCID: PMC11431971 DOI: 10.3390/jcm13185408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2024] [Revised: 09/06/2024] [Accepted: 09/11/2024] [Indexed: 09/30/2024] Open
Abstract
Atrial fibrillation (AF) is the most prevalent arrhythmia among adults worldwide, frequently co-occurring with comorbidities such as Heart Failure (HF) and Type 2 Diabetes Mellitus (T2DM). This association contributes to increased morbidity and mortality, elevated healthcare costs, and diminished quality of life. Consequently, preventing or delaying the onset and recurrence of AF is crucial for reducing the incidence of complications. Sodium-glucose cotransporter 2 inhibitors (SGLT2is), due to their multifaceted pharmacological actions, have been proposed as potential therapeutic agents in the management of AF. However, current evidence from both animal models and clinical studies remains inconclusive. This narrative literature review aims to provide a comprehensive analysis of existing evidence on the impact of SGLT2is on the prevalence, incidence of new-onset, and recurrence of AF in diabetic populations and patients with HF. Numerous observational studies, predominantly retrospective, suggest a consistent reduction in AF risk with SGLT2is, while randomized controlled trials (RCTs) have yielded mixed results, with some demonstrating benefits and others not reaching statistical significance. The heterogeneity in study outcomes, population characteristics, follow-up duration, and specific SGLT2is used, as well as potential biases, underscore the need for further extensive and rigorous RCTs to establish definitive conclusions and elucidate the underlying mechanisms.
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Affiliation(s)
- Panagiotis Stachteas
- Second Cardiology Department, Medical School, Hippokration General Hospital, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Athina Nasoufidou
- Second Cardiology Department, Medical School, Hippokration General Hospital, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Efstratios Karagiannidis
- Second Cardiology Department, Medical School, Hippokration General Hospital, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Dimitrios Patoulias
- Outpatient Department of Cardiometabolic Medicine, Second Cardiology Department, Medical School, Hippokration General Hospital, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Paschalis Karakasis
- Second Cardiology Department, Medical School, Hippokration General Hospital, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Sophia Alexiou
- Second Cardiology Department, Medical School, Hippokration General Hospital, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Athanasios Samaras
- Second Cardiology Department, Medical School, Hippokration General Hospital, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Georgios Zormpas
- Second Cardiology Department, Medical School, Hippokration General Hospital, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - George Stavropoulos
- Second Cardiology Department, Medical School, Hippokration General Hospital, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Dimitrios Tsalikakis
- Department of Electrical and Computer Engineering, University of Western Macedonia, 50100 Kozani, Greece
| | - George Kassimis
- Second Cardiology Department, Medical School, Hippokration General Hospital, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Christodoulos Papadopoulos
- Third Cardiology Department, Medical School, Hippokration General Hospital, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Nikolaos Fragakis
- Second Cardiology Department, Medical School, Hippokration General Hospital, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
- Outpatient Department of Cardiometabolic Medicine, Second Cardiology Department, Medical School, Hippokration General Hospital, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
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Minciună IA, Tomoaia R, Mihăilă D, Cismaru G, Puiu M, Roșu R, Simu G, Frîngu F, Irimie DA, Caloian B, Zdrenghea D, Pop D. Recent Advances in Understanding the Molecular Mechanisms of SGLT2 Inhibitors in Atrial Remodeling. Curr Issues Mol Biol 2024; 46:9607-9623. [PMID: 39329923 PMCID: PMC11430639 DOI: 10.3390/cimb46090571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2024] [Revised: 08/26/2024] [Accepted: 08/30/2024] [Indexed: 09/28/2024] Open
Abstract
Atrial cardiomyopathy and remodeling play pivotal roles in the development of atrial fibrillation (AF) and heart failure (HF), involving complex changes in atrial structure and function. These changes facilitate the progression of AF and HF by creating a dynamic interplay between mechanical stress and electrical disturbances in the heart. Sodium-glucose cotransporter 2 inhibitors (SGLT2is), initially developed for the management of type 2 diabetes, have demonstrated promising cardiovascular benefits, being currently one of the cornerstone treatments in HF management. Despite recent data from randomized clinical trials indicating that SGLT2is may significantly influence atrial remodeling, their overall effectiveness in this context is still under debate. Given the emerging evidence, this review examines the molecular mechanisms through which SGLT2is exert their effects on atrial remodeling, aiming to clarify their potential benefits and limitations. By exploring these mechanisms, this review aims to provide insights into how SGLT2is can be integrated into strategies for preventing the progression of atrial remodeling and HF, as well as the development of AF.
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Affiliation(s)
- Ioan-Alexandru Minciună
- 5th Department of Internal Medicine, Faculty of Medicine, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania; (I.-A.M.); (D.M.); (G.C.); (R.R.); (F.F.); (D.A.I.); (B.C.); (D.Z.); (D.P.)
- Cardiology Department, Rehabilitation Hospital, 400066 Cluj-Napoca, Romania;
| | - Raluca Tomoaia
- 5th Department of Internal Medicine, Faculty of Medicine, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania; (I.-A.M.); (D.M.); (G.C.); (R.R.); (F.F.); (D.A.I.); (B.C.); (D.Z.); (D.P.)
- Cardiology Department, Rehabilitation Hospital, 400066 Cluj-Napoca, Romania;
| | - Dragos Mihăilă
- 5th Department of Internal Medicine, Faculty of Medicine, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania; (I.-A.M.); (D.M.); (G.C.); (R.R.); (F.F.); (D.A.I.); (B.C.); (D.Z.); (D.P.)
| | - Gabriel Cismaru
- 5th Department of Internal Medicine, Faculty of Medicine, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania; (I.-A.M.); (D.M.); (G.C.); (R.R.); (F.F.); (D.A.I.); (B.C.); (D.Z.); (D.P.)
- Cardiology Department, Rehabilitation Hospital, 400066 Cluj-Napoca, Romania;
| | - Mihai Puiu
- Cardiology Department, Rehabilitation Hospital, 400066 Cluj-Napoca, Romania;
| | - Radu Roșu
- 5th Department of Internal Medicine, Faculty of Medicine, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania; (I.-A.M.); (D.M.); (G.C.); (R.R.); (F.F.); (D.A.I.); (B.C.); (D.Z.); (D.P.)
- Cardiology Department, Rehabilitation Hospital, 400066 Cluj-Napoca, Romania;
| | - Gelu Simu
- 5th Department of Internal Medicine, Faculty of Medicine, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania; (I.-A.M.); (D.M.); (G.C.); (R.R.); (F.F.); (D.A.I.); (B.C.); (D.Z.); (D.P.)
- Cardiology Department, Rehabilitation Hospital, 400066 Cluj-Napoca, Romania;
| | - Florina Frîngu
- 5th Department of Internal Medicine, Faculty of Medicine, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania; (I.-A.M.); (D.M.); (G.C.); (R.R.); (F.F.); (D.A.I.); (B.C.); (D.Z.); (D.P.)
- Cardiology Department, Rehabilitation Hospital, 400066 Cluj-Napoca, Romania;
| | - Diana Andrada Irimie
- 5th Department of Internal Medicine, Faculty of Medicine, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania; (I.-A.M.); (D.M.); (G.C.); (R.R.); (F.F.); (D.A.I.); (B.C.); (D.Z.); (D.P.)
- Cardiology Department, Rehabilitation Hospital, 400066 Cluj-Napoca, Romania;
| | - Bogdan Caloian
- 5th Department of Internal Medicine, Faculty of Medicine, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania; (I.-A.M.); (D.M.); (G.C.); (R.R.); (F.F.); (D.A.I.); (B.C.); (D.Z.); (D.P.)
- Cardiology Department, Rehabilitation Hospital, 400066 Cluj-Napoca, Romania;
| | - Dumitru Zdrenghea
- 5th Department of Internal Medicine, Faculty of Medicine, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania; (I.-A.M.); (D.M.); (G.C.); (R.R.); (F.F.); (D.A.I.); (B.C.); (D.Z.); (D.P.)
| | - Dana Pop
- 5th Department of Internal Medicine, Faculty of Medicine, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania; (I.-A.M.); (D.M.); (G.C.); (R.R.); (F.F.); (D.A.I.); (B.C.); (D.Z.); (D.P.)
- Cardiology Department, Rehabilitation Hospital, 400066 Cluj-Napoca, Romania;
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Myasoedova VA, Bozzi M, Valerio V, Moschetta D, Massaiu I, Rusconi V, Di Napoli D, Ciccarelli M, Parisi V, Agostoni P, Genovese S, Poggio P. Anti-Inflammation and Anti-Oxidation: The Key to Unlocking the Cardiovascular Potential of SGLT2 Inhibitors and GLP1 Receptor Agonists. Antioxidants (Basel) 2023; 13:16. [PMID: 38275636 PMCID: PMC10812629 DOI: 10.3390/antiox13010016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 12/12/2023] [Accepted: 12/14/2023] [Indexed: 01/27/2024] Open
Abstract
Type 2 diabetes mellitus (T2DM) is a prevalent and complex metabolic disorder associated with various complications, including cardiovascular diseases. Sodium-glucose co-transporter 2 inhibitors (SGLT2i) and glucagon-like peptide 1 receptor agonists (GLP1-RA) have emerged as novel therapeutic agents for T2DM, primarily aiming to reduce blood glucose levels. However, recent investigations have unveiled their multifaceted effects, extending beyond their glucose-lowering effect. SGLT2i operate by inhibiting the SGLT2 receptor in the kidneys, facilitating the excretion of glucose through urine, leading to reduced blood glucose levels, while GLP1-RA mimic the action of the GLP1 hormone, stimulating glucose-dependent insulin secretion from pancreatic islets. Both SGLT2i and GLP1-RA have shown remarkable benefits in reducing major cardiovascular events in patients with and without T2DM. This comprehensive review explores the expanding horizons of SGLT2i and GLP1-RA in improving cardiovascular health. It delves into the latest research, highlighting the effects of these drugs on heart physiology and metabolism. By elucidating their diverse mechanisms of action and emerging evidence, this review aims to recapitulate the potential of SGLT2i and GLP1-RA as therapeutic options for cardiovascular health beyond their traditional role in managing T2DM.
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Affiliation(s)
- Veronika A. Myasoedova
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (V.A.M.); (M.B.); (V.V.); (D.M.); (I.M.); (V.R.); (P.A.); (S.G.)
| | - Michele Bozzi
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (V.A.M.); (M.B.); (V.V.); (D.M.); (I.M.); (V.R.); (P.A.); (S.G.)
| | - Vincenza Valerio
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (V.A.M.); (M.B.); (V.V.); (D.M.); (I.M.); (V.R.); (P.A.); (S.G.)
| | - Donato Moschetta
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (V.A.M.); (M.B.); (V.V.); (D.M.); (I.M.); (V.R.); (P.A.); (S.G.)
| | - Ilaria Massaiu
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (V.A.M.); (M.B.); (V.V.); (D.M.); (I.M.); (V.R.); (P.A.); (S.G.)
| | - Valentina Rusconi
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (V.A.M.); (M.B.); (V.V.); (D.M.); (I.M.); (V.R.); (P.A.); (S.G.)
| | - Daniele Di Napoli
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84084 Fisciano, Italy; (D.D.N.); (M.C.)
| | - Michele Ciccarelli
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84084 Fisciano, Italy; (D.D.N.); (M.C.)
| | - Valentina Parisi
- Department of Translational Medical Sciences, Federico II University, 80138 Naples, Italy;
| | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (V.A.M.); (M.B.); (V.V.); (D.M.); (I.M.); (V.R.); (P.A.); (S.G.)
| | - Stefano Genovese
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (V.A.M.); (M.B.); (V.V.); (D.M.); (I.M.); (V.R.); (P.A.); (S.G.)
| | - Paolo Poggio
- Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (V.A.M.); (M.B.); (V.V.); (D.M.); (I.M.); (V.R.); (P.A.); (S.G.)
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Vrachatis DA, Papathanasiou KA, Giotaki SG, Raisakis K, Kaoukis A, Kossyvakis C, Theodorakis A, Pediotidis S, Avramides D, Siasos G, Deftereos S. Advances in the Management of Heart Failure with Reduced Ejection Fraction; The Role of SGLT2is, ARNI, Myotropes, Vericiguat, and Anti-inflammatory Agents: A Mini-review. Curr Pharm Des 2023; 29:509-518. [PMID: 36927423 DOI: 10.2174/1381612829666230316142450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 01/22/2023] [Accepted: 01/24/2023] [Indexed: 03/18/2023]
Abstract
Heart failure with reduced ejection fraction (HFrEF) has been associated with poor prognosis, reduced quality of life, and increased healthcare expenditure. Despite tremendous advances in HFrEF management, reduced survival and a high rate of hospitalization remain unsolved issues. Furthermore, HFrEF morbidity and economic burden are estimated to increase in the following years; hence, new therapies are constantly emerging. In the last few years, a series of landmark clinical trials have expanded our therapeutic armamentarium with a ground-breaking change in HFrEF-related outcomes. Sodium-glucose co-transporter 2 inhibitors (mainly dapagliflozin and empagliflozin) have already revolutionized the management of HFrEF patients via a significant reduction in cardiovascular mortality and heart failure hospitalizations. Furthermore, vericiguat and omecamtiv mecarbil have emerged as promising and novel disease-modifying therapies. The former restores the impaired cyclic guanosine monophosphate pathway, and the latter stimulates cardiac myosin without marked arrhythmogenesis. Both vericiguat and omecamtiv mecarbil have been shown to reduce heart failure admissions. Sacubitril/valsartan is an established and effective therapy in HFrEF patients and should be considered as a replacement for angiotensin-converting enzyme inhibitors (ACEi) or angiotensin II receptor blockers (ARBs). Lastly, inflammasome activity is implicated in HFrEF pathophysiology, and the role of anti-inflammatory agents in HFrEF trajectories is readily scrutinized, yet available therapies are ineffective. This mini-review summarizes the major and most recent studies in this field, thus covering the current advances in HFrEF therapeutics.
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Affiliation(s)
| | - Konstantinos A Papathanasiou
- Second Department of Cardiology, National & Kapodistrian University of Athens, School of Medicine, University General Hospital ATTIKON, Athens, Greece
| | - Sotiria G Giotaki
- Second Department of Cardiology, National & Kapodistrian University of Athens, School of Medicine, University General Hospital ATTIKON, Athens, Greece
| | | | - Andreas Kaoukis
- Deparment of Cardiology, General Hospital of Athens "G.Gennimatas", Athens, Greece
| | | | - Andreas Theodorakis
- Deparment of Cardiology, General Hospital of Athens "G.Gennimatas", Athens, Greece
| | - Stauros Pediotidis
- Deparment of Cardiology, General Hospital of Athens "G.Gennimatas", Athens, Greece
| | - Dimitrios Avramides
- Deparment of Cardiology, General Hospital of Athens "G.Gennimatas", Athens, Greece
| | - Gerasimos Siasos
- Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Sotiria Chest Disease Hospital, Athens, Greece
| | - Spyridon Deftereos
- Department of Cardiology, National & Kapodistrian University of Athens, School of Medicine, University General Hospital ATTIKON, Athens, Greece
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Scheen AJ. Antidiabetic agents and risk of atrial fibrillation/flutter: A comparative critical analysis with a focus on differences between SGLT2 inhibitors and GLP-1 receptor agonists. DIABETES & METABOLISM 2022; 48:101390. [DOI: 10.1016/j.diabet.2022.101390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 09/22/2022] [Accepted: 09/22/2022] [Indexed: 04/11/2023]
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Li C, Yu J, Hockham C, Perkovic V, Neuen BL, Badve SV, Houston L, Lee VYJ, Barraclough JY, Fletcher RA, Mahaffey KW, Heerspink HJL, Cannon CP, Neal B, Arnott C. Canagliflozin and atrial fibrillation in type 2 diabetes mellitus: A secondary analysis from the CANVAS Program and CREDENCE trial and meta-analysis. Diabetes Obes Metab 2022; 24:1927-1938. [PMID: 35589614 DOI: 10.1111/dom.14772] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 05/07/2022] [Accepted: 05/17/2022] [Indexed: 01/10/2023]
Abstract
AIM To assess the effects of canagliflozin on the incidence of atrial fibrillation/atrial flutter (AF/AFL) and other key cardiorenal outcomes in a pooled analysis of the CANVAS and CREDENCE trials. MATERIALS AND METHODS Participants with type 2 diabetes and high risk of cardiovascular disease or chronic kidney disease were included and randomly assigned to canagliflozin or placebo. We explored the effects of canagliflozin on the incidence of first AF/AFL events and AF/AFL-related complications (ischaemic stroke/transient ischaemic attack/hospitalization for heart failure). Major adverse cardiovascular events and a renal-specific outcome by baseline AF/AFL status were analysed using Cox regression models. RESULTS Overall, 354 participants experienced a first AF/AFL event. Canagliflozin had no detectable effect on AF/AFL (hazard ratio [HR] 0.82, 95% confidence interval [CI] 0.67-1.02) compared with placebo. Subgroup analysis, however, suggested a possible reduction in AF/AFL in those with no AF/AFL history (HR 0.78, 95% CI 0.62-0.99). Canagliflozin was also associated with a reduction in AF/AFL-related complications (HR 0.74, 95% CI 0.65-0.86). There was no evidence of treatment heterogeneity by baseline AF/AFL history for other key cardiorenal outcomes (all Pinteraction > 0.14). Meta-analysis of five sodium-glucose cotransporter-2 (SGLT2) inhibitor trials demonstrated a 19% reduction in AF/AFL events with active treatment (HR 0.81, 95% CI 0.72-0.92). CONCLUSIONS Overall, a significant effect of canagliflozin on the incidence of AF/AFL events could not be shown, however, a possible reduction in AF/AFL events in those with no prior history requires further investigation. Meta-analysis suggests SGLT2 inhibition reduces AF/AFL incidence.
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Affiliation(s)
- Chao Li
- Cardiovascular Centre, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- The George Institute for Global Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Jie Yu
- The George Institute for Global Health, UNSW Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Department of Cardiology, Peking University Third Hospital, Beijing, China
| | - Carinna Hockham
- The George Institute for Global Health, School of Public Health, Imperial College London, London, UK
| | - Vlado Perkovic
- The George Institute for Global Health, UNSW Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- The Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Brendon L Neuen
- The George Institute for Global Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Sunil V Badve
- The George Institute for Global Health, UNSW Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Department of Nephrology, St George Hospital, Sydney, Australia
| | - Lauren Houston
- The George Institute for Global Health, UNSW Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Vivian Y J Lee
- The George Institute for Global Health, UNSW Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | | | - Robert A Fletcher
- The George Institute for Global Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Kenneth W Mahaffey
- Stanford Center for Clinical Research, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Hiddo J L Heerspink
- The George Institute for Global Health, UNSW Sydney, Sydney, New South Wales, Australia
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Christopher P Cannon
- Cardiovascular Division, Brigham & Women's Hospital and Baim Institute for Clinical Research, Boston, Massachusetts, USA
| | - Bruce Neal
- The George Institute for Global Health, UNSW Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Imperial College London, London, UK
| | - Clare Arnott
- The George Institute for Global Health, UNSW Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
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Yildiz M, Lavie CJ, Morin DP, Oktay AA. The complex interplay between diabetes mellitus and atrial fibrillation. Expert Rev Cardiovasc Ther 2022; 20:707-717. [PMID: 35984314 DOI: 10.1080/14779072.2022.2115357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
INTRODUCTION : A growing body of evidence suggests that diabetes mellitus (DM) is associated with an increased risk of new-onset atrial fibrillation (AF) and contributes to suboptimal arrhythmia control and poor prognosis in patients with AF. The high prevalence of AF among patients with DM is primarily attributed to common risk factors, shared pathophysiological mechanisms, and associated atrial remodeling and autonomic dysfunction. AREAS COVERED : This comprehensive review covers the current data on the role of DM in the development and prognosis of AF. In addition, we review the impact of anti-DM medications on AF prevention and the role of anticoagulation in patients with coexisting DM and AF. EXPERT OPINION : DM is independently associated with new-onset AF, and the coexistence of these two conditions contributes to poor outcomes, from reduced quality of life to increased risks of thromboembolic events, heart failure, and mortality. Despite this strong link, the current evidence is insufficient to recommend routine screening for AF in patients with DM. Although some observations exist on preventing AF with anti-DM medications, randomized controlled trials are warranted to explore the proposed benefits of novel anti-DM medicines in reducing the risk of incident AF.
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Affiliation(s)
- Mehmet Yildiz
- The Carl and Edyth Lindner Center for Research and Education at The Christ Hospital, Cincinnati, OH
| | - Carl J Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School-The University of Queensland School of Medicine, New Orleans, LA
| | - Daniel P Morin
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School-The University of Queensland School of Medicine, New Orleans, LA
| | - Ahmet Afsin Oktay
- The Heart and Vascular Institute, Rush University Medical Center, Chicago, IL
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Karamichalakis N, Kolovos V, Paraskevaidis I, Tsougos E. A New Hope: Sodium-Glucose Cotransporter-2 Inhibition to Prevent Atrial Fibrillation. J Cardiovasc Dev Dis 2022; 9:jcdd9080236. [PMID: 35893226 PMCID: PMC9331782 DOI: 10.3390/jcdd9080236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 07/17/2022] [Accepted: 07/22/2022] [Indexed: 11/16/2022] Open
Abstract
Atrial arrhythmias are common in patients with diabetes mellitus (DM), and despite recent advances in pharmaceutical and invasive treatments, atrial fibrillation (AF) and atrial flutter (AFl) are still associated with substantial mortality and morbidity. Clinical trial data imply a protective effect of sodium-glucose cotransporter-2 inhibitors (SGLT2is) on the occurrence of AF and AFl. This review summarizes the state of knowledge regarding DM-mediated mechanisms responsible for AF genesis and recurrence but also discusses the recent data from experimental studies, published trials and metanalyses.
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Yin Z, Zheng H, Guo Z. Effect of Sodium-Glucose Co-transporter Protein 2 Inhibitors on Arrhythmia in Heart Failure Patients With or Without Type 2 Diabetes: A Meta-Analysis of Randomized Controlled Trials. Front Cardiovasc Med 2022; 9:902923. [PMID: 35665272 PMCID: PMC9157597 DOI: 10.3389/fcvm.2022.902923] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 05/04/2022] [Indexed: 01/10/2023] Open
Abstract
Aim Arrhythmic events such as atrial fibrillation (AF) are tightly associated with an increased risk of heart failure (HF). Previous studies have shown inconsistent results regarding the association between sodium-glucose co-transporter 2 inhibitors (SGLT2i) and the risk of arrhythmia. The purpose of this study was to investigate the association of SGLT2i treatment with arrhythmia outcomes in clinical trials of patients with HF. Methods We searched Embase, PubMed, Web of Science, Medline, The Cochrane Library, and JAMA databases to identify appropriate randomized controlled trials (RCTs) of SGLT2i interventions. Endpoint outcomes included AF, atrial flutter (AFL), AF/AFL, ventricular fibrillation (VF), ventricular tachycardia (VT), VF/VT, and bradycardia. A random-effects model was used for the meta-analysis of all outcomes. The risk of bias and quality of evidence was assessed by using the Cochrane tool and assessment framework. Results Out of 1,725 citations, 9 trials were included in this study, with follow-up from 4 weeks to 52 weeks for 10,344 participants (mean age 68.27 years; 69.62% of participants were men). Compared with placebo, SGLT2i reduced the incidence of AF by 37% [ratio risk (RR) 0.63; 95% confidence interval (CI) 0.45–0.87; p < 0.05] and AF/AFL by 34% (RR 0.66; 95% CI 0.49–0.90; p < 0.05). Conclusions SGLT2i can reduce the risk of cardiac arrhythmias, particularly the AF. Our study provides strong evidence for recommending the use of SGLT2i in patients with HF. Systematic Review Registration PROSPERO, identifier: CRD42022296696.
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Affiliation(s)
- Ziwei Yin
- Department of Cardiology, The First Affiliated Hospital of Hunan University of Chinese Medicine, Changsha, China
| | - Huizhen Zheng
- Department of Cardiology, The First Affiliated Hospital of Hunan University of Chinese Medicine, Changsha, China
| | - Zhihua Guo
- College of Chinese Medicine, Hunan University of Chinese Medicine, Changsha, China
- *Correspondence: Zhihua Guo
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Calvert P, Farinha JM, Gupta D, Kahn M, Proietti R, Lip GYH. A comparison of medical therapy and ablation for atrial fibrillation in patients with heart failure. Expert Rev Cardiovasc Ther 2022; 20:169-183. [DOI: 10.1080/14779072.2022.2050695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Peter Calvert
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
| | - José Maria Farinha
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Dhiraj Gupta
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Matthew Kahn
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Riccardo Proietti
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Gregory Y. H. Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
- Department of Clinical Medicine, Aalborg University, Denmark
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Scheen AJ. Efficacy / safety balance of DPP-4 inhibitors versus SGLT2 inhibitors in elderly patients with type 2 diabetes. DIABETES & METABOLISM 2021; 47:101275. [PMID: 34481962 DOI: 10.1016/j.diabet.2021.101275] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 08/07/2021] [Indexed: 12/14/2022]
Abstract
Dipeptidyl peptidase-4 inhibitors (DPP-4is) and sodium-glucose cotransporter type 2 inhibitors (SGLT2is) offer new options for the oral management of type 2 diabetes mellitus (T2DM), with the advantage in the elderly population to be devoid of a high risk of hypoglycaemia. SGLT2is have also shown benefits regarding cardiovascular (heart failure) and renal protection, including in patients with T2DM aged ≥ 65 years while DPP-4is have only proved cardiovascular and renal safety without superiority compared with placebo. The glucose-lowering efficacy of the two pharmacological classes is almost similar including in older patients with T2DM. However, the tolerance and safety profile may be highly different and overall more favourable with DPP-4is than with SGLT2is. Some adverse events have been reported with SGLT2is which may be more prevalent or severe in older patients than in younger patients. The present comprehensive review focuses on the benefit/risk balance in the elderly population with T2DM by comparing the profile of DPP-4is and SGLT2is regarding the following potential issues: metabolic disorders (hypoglycaemia and diabetic ketoacidosis); cardiac and vascular issues (atheromatous cardiovascular disease, heart failure, volume reduction hypotension, and lower limb amputations); renal endpoints including acute renal injury; risk of infections; digestive disorders; bone and skin adverse events; and cancer risk. Both DPP-4is and SGLT2is have their own advantages and disadvantages. Personalised treatment is recommended based upon the efficacy/safety profile of each drug class and individual patient characteristics that may be markedly different among the heterogeneous population of older individuals with T2DM.
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Affiliation(s)
- André J Scheen
- Division of Clinical Pharmacology, Centre for Interdisciplinary Research on Medicines (CIRM), University of Liège, Liège, Belgium; Division of Diabetes, Nutrition and Metabolic Disorders, Department of Medicine, CHU Liège, Liège, Belgium.
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