Sodium‐Glucose Cotransporter‐2 Inhibitor Prevents Stroke in Patients With Diabetes and Atrial Fibrillation
Background Atrial fibrillation (AF) is associated with increasing risk of thromboembolic or ischemic stroke. The CHA2DS2‐VASc score is a well‐established predictor of AF stroke. Patients with AF have an increased risk of stroke if they have diabetes. Use of sodium‐glucose cotransporter‐2 inhibitor (...
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| Format: | Article |
| Language: | English |
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Wiley
2023-05-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.122.027764 |
| _version_ | 1827942887818526720 |
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| author | Sheng‐Nan Chang Jien‐Jiun Chen Pang‐Shuo Huang Cho‐Kai Wu Yi‐Chih Wang Juey‐Jen Hwang Chia‐Ti Tsai |
| author_facet | Sheng‐Nan Chang Jien‐Jiun Chen Pang‐Shuo Huang Cho‐Kai Wu Yi‐Chih Wang Juey‐Jen Hwang Chia‐Ti Tsai |
| author_sort | Sheng‐Nan Chang |
| collection | DOAJ |
| description | Background Atrial fibrillation (AF) is associated with increasing risk of thromboembolic or ischemic stroke. The CHA2DS2‐VASc score is a well‐established predictor of AF stroke. Patients with AF have an increased risk of stroke if they have diabetes. Use of sodium‐glucose cotransporter‐2 inhibitor (SGLT2i) has been shown to be associated with favorable cardiovascular outcomes in patients with diabetes. It was unknown whether use of SGLT2i decreased stroke risk in patients with AF who have diabetes. Methods and Results A total of 9116 patients with AF and diabetes from the National Taiwan University historical cohort were longitudinally followed up for 5 years (January 2016–December 2020). The risk of stroke related to SGLT2i use was evaluated by Cox model, adjusting CHA2DS2‐VASc score in the propensity score–matched population with 474 SGLT2i users and 3235 nonusers. Adverse thromboembolic end points during follow‐up were defined as ischemic stroke. The mean age was 73.2±10.5 years, and 61% of patients were men. There were no significant differences of baseline characteristics between users and nonusers of SGLT2i, including CHA2DS2‐VASc score in the propensity score–matched population. The stroke rate was 3.4% (95% CI, 2.8–4.2) patient‐years in SGLT2i users and 4.3% (95% CI, 4.0–4.6) in nonusers (P=0.021). SGLT2i users had a 20% reduction of stroke (hazard ratio, 0.80 [95% CI, 0.64–0.99]; P=0.043) after adjustment for the CHA2DS2‐VASc score. Conclusions Use of SGLT2i was associated with a lower stroke risk in patients with diabetes and AF, and it may be considered to escalate SGLT2i to the first‐line treatment in patients with diabetes and AF. |
| first_indexed | 2024-03-13T10:06:24Z |
| format | Article |
| id | doaj.art-5c1bb2a1c4b448cab6a8d17f9691846d |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-03-13T10:06:24Z |
| publishDate | 2023-05-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-5c1bb2a1c4b448cab6a8d17f9691846d2023-05-22T11:34:50ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802023-05-01121010.1161/JAHA.122.027764Sodium‐Glucose Cotransporter‐2 Inhibitor Prevents Stroke in Patients With Diabetes and Atrial FibrillationSheng‐Nan Chang0Jien‐Jiun Chen1Pang‐Shuo Huang2Cho‐Kai Wu3Yi‐Chih Wang4Juey‐Jen Hwang5Chia‐Ti Tsai6Division of Cardiology, Department of Internal Medicine National Taiwan University Hospital Yun‐Lin Branch Yun‐Lin TaiwanDivision of Cardiology, Department of Internal Medicine National Taiwan University Hospital Yun‐Lin Branch Yun‐Lin TaiwanDivision of Cardiology, Department of Internal Medicine National Taiwan University Hospital Yun‐Lin Branch Yun‐Lin TaiwanDivision of Cardiology, Department of Internal Medicine National Taiwan University Hospital Taipei TaiwanDivision of Cardiology, Department of Internal Medicine National Taiwan University Hospital Taipei TaiwanDivision of Cardiology, Department of Internal Medicine National Taiwan University Hospital Taipei TaiwanDivision of Cardiology, Department of Internal Medicine National Taiwan University Hospital Taipei TaiwanBackground Atrial fibrillation (AF) is associated with increasing risk of thromboembolic or ischemic stroke. The CHA2DS2‐VASc score is a well‐established predictor of AF stroke. Patients with AF have an increased risk of stroke if they have diabetes. Use of sodium‐glucose cotransporter‐2 inhibitor (SGLT2i) has been shown to be associated with favorable cardiovascular outcomes in patients with diabetes. It was unknown whether use of SGLT2i decreased stroke risk in patients with AF who have diabetes. Methods and Results A total of 9116 patients with AF and diabetes from the National Taiwan University historical cohort were longitudinally followed up for 5 years (January 2016–December 2020). The risk of stroke related to SGLT2i use was evaluated by Cox model, adjusting CHA2DS2‐VASc score in the propensity score–matched population with 474 SGLT2i users and 3235 nonusers. Adverse thromboembolic end points during follow‐up were defined as ischemic stroke. The mean age was 73.2±10.5 years, and 61% of patients were men. There were no significant differences of baseline characteristics between users and nonusers of SGLT2i, including CHA2DS2‐VASc score in the propensity score–matched population. The stroke rate was 3.4% (95% CI, 2.8–4.2) patient‐years in SGLT2i users and 4.3% (95% CI, 4.0–4.6) in nonusers (P=0.021). SGLT2i users had a 20% reduction of stroke (hazard ratio, 0.80 [95% CI, 0.64–0.99]; P=0.043) after adjustment for the CHA2DS2‐VASc score. Conclusions Use of SGLT2i was associated with a lower stroke risk in patients with diabetes and AF, and it may be considered to escalate SGLT2i to the first‐line treatment in patients with diabetes and AF.https://www.ahajournals.org/doi/10.1161/JAHA.122.027764atrial fibrillationdiabetesoral hypoglycemic agentsodium‐glucose cotransporter‐2 inhibitorstrokethromboembolism |
| spellingShingle | Sheng‐Nan Chang Jien‐Jiun Chen Pang‐Shuo Huang Cho‐Kai Wu Yi‐Chih Wang Juey‐Jen Hwang Chia‐Ti Tsai Sodium‐Glucose Cotransporter‐2 Inhibitor Prevents Stroke in Patients With Diabetes and Atrial Fibrillation Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease atrial fibrillation diabetes oral hypoglycemic agent sodium‐glucose cotransporter‐2 inhibitor stroke thromboembolism |
| title | Sodium‐Glucose Cotransporter‐2 Inhibitor Prevents Stroke in Patients With Diabetes and Atrial Fibrillation |
| title_full | Sodium‐Glucose Cotransporter‐2 Inhibitor Prevents Stroke in Patients With Diabetes and Atrial Fibrillation |
| title_fullStr | Sodium‐Glucose Cotransporter‐2 Inhibitor Prevents Stroke in Patients With Diabetes and Atrial Fibrillation |
| title_full_unstemmed | Sodium‐Glucose Cotransporter‐2 Inhibitor Prevents Stroke in Patients With Diabetes and Atrial Fibrillation |
| title_short | Sodium‐Glucose Cotransporter‐2 Inhibitor Prevents Stroke in Patients With Diabetes and Atrial Fibrillation |
| title_sort | sodium glucose cotransporter 2 inhibitor prevents stroke in patients with diabetes and atrial fibrillation |
| topic | atrial fibrillation diabetes oral hypoglycemic agent sodium‐glucose cotransporter‐2 inhibitor stroke thromboembolism |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.122.027764 |
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