Dapagliflozin may curb atrial fibrillation and flutter in diabetics

By David Douglas

NEW YORK (Reuters Health) - 5/2/2020

The sodium-glucose cotransporter 2 (SGLT2) inhibitor dapagliflozin may lead to a slight reduction in some heart arrhythmias in addition to lowering blood sugar in patients with type 2 diabetes, according to an international group of researchers.

In an email to Reuters Health, Dr. Stephen D. Wiviott said this class of drugs has already "been shown to have multiple favorable effects including reductions in heart failure and kidney failure in a broad population of patients."

The new findings for the first time "suggest that there may be an additional benefit of reducing new and recurrent atrial fibrillation," he added. Dr. Wiviott, of Brigham and Women's Hospital in Boston, and colleagues conducted post-hoc analyses of a the DECLARE-TIMI 58 trial, which tested dapagliflozin against placebo in more than 17,000 patients with type 2 diabetes and atherosclerotic cardiovascular disease or multiple risk factors for such disease.

At baseline 1,116 patients (6.5%) had a known history of atrial fibrillation (AF) and atrial flutter (AFL). During the trial, 769 AF/AFL events occurred in 589 patients over a median follow-up of 4.2 years. Most were single events although 20 patients had four or more, the researchers report in Circulation. In patients on dapagliflozin, the rate of a first AF/AFL event was 7.8 per 1,000 patient-years, versus 9.6 in those on placebo (hazard ratio, 0.81; P=0.009).

This reduction was consistent regardless of baseline AF/AFL history. This was also true of other potentially modifying factors including known atherosclerotic cardiovascular disease or a history of heart failure as well as sex, BMI and blood pressure.

These results, the researchers conclude, offer another potential benefit of the use of SGLT2 inhibitors "given the frequent clinical occurrence of T2DM and AF/AFL in the same patients."

The trial was funded by AstraZeneca. Dr. Wiviott and several of his coauthors report financial ties to the company.

SOURCE: https://bit.ly/2Uplomk

Circulation, online January 27, 2020.

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