Dapagliflozin lowers risk for Afib in high-risk patients with T2D

  • Zelniker TA & al.
  • Circulation
  • 27 Jan 2020

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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Takeaway

  • In patients with type 2 diabetes (T2D), dapagliflozin reduced the incidence of reported episodes of atrial fibrillation (Afib)/atrial flutter (AFL) adverse events, irrespective of the prevalence of Afib, atherosclerotic cardiovascular disease (ASCVD) and heart failure (HF).

Why this matters

  • Findings provide the first clinical evidence for a favourable effect of sodium-glucose cotransporter 2 inhibitors (SGLT2is) on the incidence of Afib or AFL with consistent findings in patients with and without known Afib or AFL.

Study design

  • Post hoc analyses investigated the effect of dapagliflozin on the first and total number of AF/AFL events in patients with (n=1,116) and without prevalent AF/AFL using data from DECLARE-TIMI 58 trial.
  • Funding: DECLARE TIMI-58 trial was funded by a grant from AstraZeneca to Brigham and Women’s Hospital.

Key results

  • Dapagliflozin significantly reduced the risk for Afib/AFL events (7.8 vs 9.6 events per 1000 patient-years; HR, 0.81; 95% CI, 0.68-0.95; P=.009).
  • Reduction in the risk for Afib/AFL events was consistent in patients with (HR, 0.79; 95% CI, 0.58-1.09) and without (HR, 0.81; 95% CI, 0.67-0.98; Pinteraction=.89) known history of Afib/AFL.
  • The reduction in Afib/AFL events associated with dapagliflozin was not affected by the presence of ASCVD (HR, 0.83; 95% CI, 0.66-1.04) vs MRF (HR, 0.78; 95% CI, 0.62-0.99; Pinteraction=.72), or a history of HF (HF: HR, 0.78; 95% CI, 0.55-1.11; and no HF: HR, 0.81; 95% CI, 0.68-0.97; Pinteraction=.88).
  • Treatment effect of dapagliflozin on the risk for Afib/AFL events did not modify by sex, history of ischaemic stroke, glycated haemoglobin, body mass index, blood pressure and eGFR (all Pinteraction>.20).
  • Dapagliflozin significantly reduced the total number (first and recurrent) of Afib/AFL events (incidence rate ratio, 0.77; 95% CI, 0.64-0.92; P=.005).

Limitations

  • Post hoc analyses.