Use of sodium-glucose cotransporter-2 inhibitors and the risk for sudden cardiac arrest and for all-cause death in patients with type 2 diabetes mellitus

Eur Heart J Cardiovasc Pharmacother. 2022 Jul 27;pvac043. doi: 10.1093/ehjcvp/pvac043. Online ahead of print.

Abstract

Aims: Sodium-glucose cotransporter-2 inhibitors (SGLT-2is) are antidiabetic agents that can have direct cardiac effects by impacting on cardiac ion transport mechanisms that control cardiac electrophysiology. We studied the association between SGLT-2i use and all-cause mortality and the risk of sudden cardiac arrest (SCA) in patients with type 2 diabetes.

Methods: Using data from the UK Clinical Practice Research Datalink, a cohort study among patients initiating a new antidiabetic drug class on or after January 2013 through September 2020 was conducted. Cox regression with time-dependent covariates was performed to estimate the hazard ratios (HRs) of SCA and all-cause mortality comparing SGLT-2is with other second- to third-line antidiabetic drugs. Stratified analyses were performed according to sex, diabetes duration (<5 or ≥ 5 years), and the presence of cardiovascular disease.

Results: A total of 152 591 patients were included. Use of SGLT-2i was associated with reduced HR of SCA when compared to other second- to third-line antidiabetic drugs after adjustment for common SCA risk factors, although this association marginally failed to reach statistical significance (HR:0.62 [95%-CI:0.38-1.01]). The HR of all-cause mortality associated with SGLT-2i use when comparing to other second-to third-line antidiabetics was 0.43 (95%-CI:0.39-0.48) and did not vary by sex, diabetes duration or the presence of cardiovascular disease. SGLT-2i use remained associated with lower all-cause mortality in patients without concomitant insulin use (HR:0.56 [95%-CI:0.50-0.63]).

Conclusion: SGLT-2i use was associated with reduced all-cause mortality in patients with type 2 diabetes. The association between use of SGLT-2i and reduced risk of SCA was not statistically significant.

Keywords: Pharmacoepidemiology; Sodium-glucose cotransporter-2 inhibitors; sudden cardiac arrest.