Considerations and treatment options for patients with comorbid atrial fibrillation and diabetes mellitus

Moss, Alexandra; Dimitropoulos, Gerasimos; Connolly, Derek; Lip, Gregory Y.H.

doi:10.1080/14656566.2017.1350647

Cited by 15 publications

(14 citation statements)

References 122 publications

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“…We confirmed that HF events were significantly decreased in patients randomized to SGLT2 inhibitors. Reductions in both HF and AF/AFL and their concomitant interventions and downstream complications might subsequently reduce the risk of all-cause mortality in our present work [ 3 , 38 ]. In particular, we found that this effect could be enhanced with therapy of a longer duration.…”

Section: Discussionmentioning

confidence: 99%

SGLT2 inhibitors and atrial fibrillation in type 2 diabetes: a systematic review with meta-analysis of 16 randomized controlled trials

Chen

et al. 2020

Cardiovasc Diabetol

105

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Background Type 2 diabetes is closely related to an increased risk of atrial fibrillation (AF) and atrial flutter (AFL). Whether sodium-glucose cotransporter 2 (SGLT2) inhibitors can attenuate AF/AFL progression remains unclear. Methods We searched electronic databases (PubMed, Embase and ClinicalTrials.gov) from their inception to January 2020 for trials evaluating the AF outcomes of SGLT2 inhibitors in patients with type 2 diabetes. The data search and extraction were conducted with a standardized data form and any conflicts were resolved by consensus. Relative risks (RRs) with 95% confidence intervals (CIs) were used for binary variables, and the weighed mean differences (WMDs) with the standard deviation (SDs) were applied for continuous variables. Results We included data from 16 identified trials consisting of 38,335 patients with type 2 diabetes. Incorporated data demonstrated that compared to placebo, SGLT2 inhibitors significantly reduced AF/AFL (RR: 0.76; 95% CI 0.65–0.90; p = 0.001) and all-cause mortality (RR: 0.91; 95% CI 0.83–0.99; p = 0.03). AF/AFL reductions were not modified by age, body weight, glycated haemoglobin (HbA1c), or systolic blood pressure (SBP) at baseline (all p-interactions > 0.3). SGLT2 inhibitors also significantly reduced heart failure events (RR: 0.73; 95% CI 0.64–0.84; p < 0.00001), HbA1c (WMD: − 0.62%; 95% CI − 0.89 to − 0.34; p < 0.00001), body weight (WMD: − 2.12 kg; 95% CI − 2.91 to − 1.34; p < 0.00001), SBP (WMD: − 3.34 mmHg; 95% CI − 4.12 to − 2.56; p < 0.00001), and diastolic blood pressure (DBP) (WMD: − 1.11 mmHg; 95% CI − 1.62 to − 0.60; p < 0.0001). Of note, cerebrovascular events and myocardial infarction did not increase in patients taking SGLT2 inhibitors. Conclusion SGLT2 inhibitors may confer a specific AF/AFL-reduction benefit in the susceptible type 2 diabetes population, regardless of age, body weight, HbA1c, and systolic blood pressure at baseline. Such an AF/AFL-reduction benefit may be partly attributed to pharmacological effects on reductions in HbA1c, body weight, blood pressure, and the occurrence of heart failure.

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Section: Discussionmentioning

confidence: 99%

SGLT2 inhibitors and atrial fibrillation in type 2 diabetes: a systematic review with meta-analysis of 16 randomized controlled trials

Chen

et al. 2020

Cardiovasc Diabetol

105

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“…Irrespective of its relationship with T2DM, AF should be appropriately managed. Therapeutic solutions include either rate control or rhythm control options and, in patients with CHA 2 DS 2 -VASc score of at least one point, anticoagulation agents should be prescribed to prevent thromboembolism and cardiovascular mortality (1,(17)(18)(19).…”

Section: Discussionmentioning

confidence: 99%

Cardio metabolic risk factors for atrial fibrillation in type 2 diabetes mellitus: Focus on hypertension, metabolic syndrome and obesity

Găman¹,

Dobrică²,

Pascu³

et al. 2019

JMMS

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Objective. Atrial fibrillation (AF) in type 2 diabetes mellitus (T2DM) has been little explored so far. However, there are several cardio metabolic risk factors for AF in T2DM patients, such as arterial hypertension, obesity or the metabolic syndrome. Our objective was to evaluate cardio metabolic risk factors for AF in T2DM patients. Methods. We studied the medical records of T2DM patients hospitalized in the Internal Medicine department of an emergency referral hospital in Bucharest, Romania. The study was observational, retrospective and carried out between January-June 2018. Results. The study group included 221 T2DM patients (with a mean age of 68.65 ± 10.64, ranging between 37-93 years): 116 women (52.49%; with a mean age of 70.53 ± 10.69, ranging between 37-93 years) and 105 men (47.51%; with a mean age of 66.57 ± 10.23, ranging between 38-91 years). 92 patients had AF (41.63%): 40 women (34.48%) and 52 men (49.52%). 180 patients (81.45%) were hypertensive: 103 women (88.79%) and 77 men (73.33%). 113 patients (51.13%) had metabolic syndrome: 58 women (50.00%) and 55 men (52.38%). 77 patients (34.84%) were obese: 45 women (38.79%) and 32 men (30.48%). AF patients associated obesity in 26 cases (28.26%), hypertension in 73 cases (79.35%) and metabolic syndrome in 56 cases (60.87%). Conclusions. Out of the study group, 92 T2DM patients (41.63%) had AF, men being more likely to suffer from AF than women (p=0.0288). Hypertension affected 180 patients (81.45%) and in greater proportion women vs. men (p=0.0051). The metabolic syndrome and obesity were discovered in 113 patients (51.13%) and 77 patients (34.84%), respectively, with no significant differences in terms of gender. In our research, the highest cardio metabolic risk factors for AF in T2DM were hypertension (OR = 3.6675) and the metabolic syndrome (OR = 3.3388).

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“…Diabetes mellitus (DM) is associated with higher risks of ischemic cardiovascular events, heart failure event irrespective to ischemic event, and mortality, and also a 40% higher risk of AF in the general population [ 4 – 7 ]. In patients with DM and established cardiovascular disease, those with AF at baseline had a higher risk of worse heart failure outcomes than those without AF [ 8 , 9 ]. Pathophysiological mechanisms including atrial electrical, structural, autonomic remodeling, oxidative stress, inflammation, and glycemic fluctuations have been suggested to explain the association between DM and occurrence of AF.…”

Section: Introductionmentioning

confidence: 99%

The risk of new-onset atrial fibrillation in patients with type 2 diabetes mellitus treated with sodium glucose cotransporter 2 inhibitors versus dipeptidyl peptidase-4 inhibitors

Ling

Chan

Chen

et al. 2020

Cardiovasc Diabetol

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Background Sodium glucose cotransporter 2 inhibitor (SGLT2i) reduces the risk of hard cardiovascular endpoints in type 2 diabetes mellitus (T2DM) patients with/without established cardiovascular diseases. Whether SGLT2i is associated with a lower risk of new-onset atrial fibrillation (AF) in T2DM patients is unclear. We aimed to evaluate the risk of new-onset AF associated with the use of SGLT2i compared to dipeptidyl peptidase-4 inhibitor (DPP4i) among a longitudinal cohort of diabetic patients. Methods We used medical data from a multi-center healthcare provider in Taiwan, which included a total of 15,606 and 12,383 patients treated with SGLT2i and DPP4i, respectively, from June 1, 2016 to December 31, 2018. We used propensity-score weighting to balance covariates across study groups. Patients were followed up from the drug index date until the occurrence of new-onset AF, discontinuation of the index drug, or the end of the study period, whichever occurred first. Results Overall, 55%, 45%, and 0% of the patients were treated with empagliflozin, dapagliflozin, and canagliflozin, respectively. Most patients in the DPP4i group were prescribed with linagliptin (51%), followed by sitagliptin (24%), saxagliptin (13%), vildagliptin (8%) and alogliptin (5%). The use of SGLT2i was associated with a lower risk of new-onset AF compared with DPP4i after propensity-score weighting [hazard ratio: 0.61; 95% confidential interval: 0.50–0.73; P < 0.001]. Subgroup analysis revealed that the use of SGLT2i was associated with a lower risk of new-onset AF compared with DPP4i across several subgroups including old age, female in gender, the presence of cardiovascular disease, hemoglobin A1c $$\ge$$ ≥ 8%, and chronic kidney disease. The advantage of SGLT2i over DPP4i persisted with different SGLT2i (dapagliflozin or empagliflozin) and either low- or standard-dose SGLT2i. Conclusions SGLT2i was associated with a lower risk of new-onset AF compared with DPP4i among T2DM patients in real-world practice.

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Considerations and treatment options for patients with comorbid atrial fibrillation and diabetes mellitus

Cited by 15 publications

References 122 publications

SGLT2 inhibitors and atrial fibrillation in type 2 diabetes: a systematic review with meta-analysis of 16 randomized controlled trials

SGLT2 inhibitors and atrial fibrillation in type 2 diabetes: a systematic review with meta-analysis of 16 randomized controlled trials

Cardio metabolic risk factors for atrial fibrillation in type 2 diabetes mellitus: Focus on hypertension, metabolic syndrome and obesity

The risk of new-onset atrial fibrillation in patients with type 2 diabetes mellitus treated with sodium glucose cotransporter 2 inhibitors versus dipeptidyl peptidase-4 inhibitors

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