Background: Type 2 diabetes is an independent risk factor for the development of atrial fibrillation (AF). However, whether reducing hyperglycemia can mitigate AF risk or not is elusive. Recently, SGLT-2i has been shown to decrease the incidence of AF through several mechanisms including reduction of atrial dilatation via diuresis and lowering body weight. On the other hand, the use of TZD was found to protect diabetic patients from new-onset AF in observational studies. Thus, we aimed to compare the effect of SGLT-2i and TZD on the risk of AF development.
Methods: Using the Korean National Health Insurance Service database, we included patients with type 2 diabetes who were prescribed SGLT-2i or TZD at least once from January 2014 to December 2018. Patients were followed until the outcome event, death, or 31 December 2018. The propensity score matching method was used to balance baseline characteristics between groups. Sensitivity analysis was performed only including patients who prescribed study drugs ≥ 90 days.
Results: After propensity matching, a total of 145,378 patients were included (72,689 patients in each treatment group). Baseline characteristics were well-balanced; mean age was ~57 years and 57.4% were male; mean body mass index was ~26.3kg/m2 and ~68.3% had hypertension. During follow-up, the incidence rates of AF were 4.84 and 5.23 per 1000 person-years in SGLT-2i-treated patients and TZD-treated patients, respectively. The hazard ratio (HR) of AF was 0.99 (95% confidence interval [CI]: 0.89-1.11) in SGLT-2i-treated patients compared with TZD-treated patients. The results remained consistent after sensitivity analysis (HR, 0.92; 95% CI: 0.78-1.08).
Conclusions: In this study, the risk of AF development was comparable in patients treated with SGLT-2i versus TZD. The risk of AF development across antidiabetic drugs with little risk of hypoglycemia might be similar.
S. Lee: None. Y. Kim: None. H. Nam: None. H. Kim: None. J. Kim: None. K. Kim: None.
