The complex interplay between SGLT2 inhibitors and atrial fibrillation: mechanisms and clinical implications

Abstract

This comprehensive review delves into the intricate relationship between Sodium-Glucose Co-Transporter 2 (SGLT2) inhibitors and AF, highlighting the multifaceted actions of these drugs and their significant cardiovascular benefits. Mechanisms: SGLT2 inhibitors induce substantial hemodynamic changes, impacting blood pressure, adipose tissue function, and inflammation. They enhance glycemic control while potentially reducing oxidative stress and inflammation, and they modulate atrial electrophysiology, collectively contributing to the reduction of AF risk. Clinical evidence: This review synthesizes a wealth of clinical evidence, drawing from observational studies and randomized controlled trials, consistently demonstrating a correlation between SGLT2 inhibitors, particularly dapagliflozin and empagliflozin, and a decreased risk of AF. This protective effect is most pronounced in patients with type 2 diabetes and heart failure, underscoring their potential as therapeutic agents for high-risk populations. Potential benefits: SGLT2 inhibitors offer a spectrum of potential benefits, including substantial reductions in AF risk, particularly in patients with type 2 diabetes and heart failure. These drugs have consistently demonstrated benefits in reducing heart failure hospitalizations, cardiovascular mortality, and stroke risk, which indirectly contribute to better AF management. Furthermore, SGLT2 inhibitors exhibit renoprotective properties by slowing the progression of chronic kidney disease and reducing albuminuria, offering substantial benefits for AF patients with comorbid kidney disease. Metabolic improvements involving weight loss, blood pressure reduction, and favorable changes in lipid profiles contribute to enhanced cardiovascular health and reduced AF risk. Originally designed for diabetes management, these medications offer a holistic approach to AF risk reduction, particularly in patients with type 2 diabetes and heart failure.