Another Win for SGLT2 Inhibitors

Volume 28, Issue 3

Sodium-glucose cotransporter-2 (SGLT2) inhibitors have taken over the fields of endocrinology, cardiology, and nephrology as the evidence for these impressive therapies continues to mount. They are now widely recommended for patients with diabetes, heart failure, and chronic kidney failure based on robust data demonstrating significant improvements in key clinical outcomes. 

In this week’s issue of Talking Therapeutics, we explore a recent study examining the impact of SGLT2 inhibitors on rates of ischemic stroke in patients with atrial fibrillation. 

Point 1: SGLT2 Inhibitors May Reduce Residual Stroke Risk

This study included 9116 patients with atrial fibrillation and diabetes from the National Taiwan University historical cohort. Patients were propensity matched according to CHA₂DS₂‐VASc score, which resulted in a well-matched cohort of 474 SGLT2 inhibitor users and 3235 nonusers.

The authors found that the stroke rate was 3.4% (95% CI, 2.8-4.2) patient‐years in SGLT2 inhibitor users and 4.3% (95% CI, 4.0-4.6) in nonusers (P = .021). Patients taking SGTL2 inhibitors had a 20% reduction of stroke (hazard ratio, 0.80 [95% CI, 0.64-0.99]; P = .043) even when adjusting for background CHA₂DS₂‐VASc score. 

Point 2: Some Unanswered Questions Remain

The deployment of the direct oral anticoagulants (DOACs) was a major breakthrough for patients with atrial fibrillation, as these agents were confirmed in several clinical trials to be much safer and possibly more effective than warfarin. Adding an SGTL2 inhibitor to a DOAC seems to represent a potent stroke reduction regimen for patients with atrial fibrillation. 

Unfortunately, the authors of this study did not report the percentage of patients who were taking oral anticoagulants, nor did they mention the breakdown of oral anticoagulant use by warfarin vs DOAC. This information would be very helpful in contextualizing the findings of this study. 

Furthermore, this is a nonrandomized database analysis, so firm conclusions regarding the ability of SGLT2 inhibitors to prevent stroke in atrial fibrillation require confirmation by a properly designed randomized clinical trial.