Effects of Sodium/Glucose Cotransporter Inhibitors on Atrial Fibrillation and Stroke: A Meta-Analysis

J Stroke Cerebrovasc Dis. 2022 Jan;31(1):106159. doi: 10.1016/j.jstrokecerebrovasdis.2021.106159. Epub 2021 Oct 22.


Objectives: Recent clinical trials have shown the potential of sodium glucose cotransporter (SGLT) 2 inhibitors to reduce the risk of atrial fibrillation but not stroke. We conducted a systematic review and meta-analysis to clarify if SGLT2 or combined SGLT1/2 inhibitors affect the risk of atrial fibrillation and stroke in patients regardless of diabetic status.

Materials and methods: Four electronic databases were searched on 21st November 2020 for studies evaluating outcomes of stroke and atrial fibrillation with SGLT2 or combined SGLT1/2 inhibitors in both diabetic and non-diabetic patients. Both random and fixed effect, pair-wise meta-analysis models were used to summarize the results of the studies.

Results: A total of 13 placebo-controlled, randomized-controlled trials were included. Eight trials comprising 35,702 patients were included in the analysis of atrial fibrillation outcomes and eight trials comprising 47,910 patients were included in the analysis of stroke outcomes. Patients on SGLT inhibitors, particularly SGLT2 inhibitors, had lower odds of atrial fibrillation (Peto odds ratio [95% confidence interval] = 0.76 [0.63-0.92]) compared to placebo. This effect remained significant with a follow-up duration longer than 1 year, in studies utilizing dapagliflozin, patients with type 2 diabetes mellitus, and patients with cardiovascular disease. No difference was observed in the odds of atrial fibrillation in patients with baseline heart failure. No effect was seen on the risk of stroke in patients taking SGLT inhibitors.

Conclusions: SGLT2 inhibitors significantly reduced the odds of atrial fibrillation in diabetic patients. However, SGLT inhibitors did not significantly affect the risk of stroke.

Keywords: Atrial fibrillation; Meta-analysis; Sodium/glucose cotransporter inhibitor; Stroke.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Atrial Fibrillation* / epidemiology
  • Atrial Fibrillation* / prevention & control
  • Diabetes Mellitus / epidemiology
  • Humans
  • Randomized Controlled Trials as Topic
  • Risk Assessment
  • Sodium-Glucose Transporter 2 Inhibitors* / therapeutic use
  • Stroke* / epidemiology
  • Stroke* / prevention & control
  • Treatment Outcome


  • Sodium-Glucose Transporter 2 Inhibitors