The risk of incident atrial fibrillation in patients with type 2 diabetes treated with sodium glucose cotransporter-2 inhibitors, glucagon-like peptide-1 receptor agonists, and dipeptidyl peptidase-4 inhibitors: a nationwide cohort study

• DOI: 10.1186/s12933-022-01549-x
• Publication Date: 2022-06-28T17:32:08Z
• Authors: Yi-Hsin Chan; Tze-Fan Chao; Shao-Wei Chen; Hsin-Fu Lee; Pei-Ru Li; Wei-Min Chen; Yung-Hsin Yeh; Chi-Tai Kuo; Lai-Chu See; Gregory Y. H. Lip
• Keywords: Discontinuation; Dipeptidyl peptidase-4 inhibitor; Lower risk

Abstract Background Although a few meta-analyses were conducted to compare the risk of incident atrial fibrillation (AF) between sodium-glucose cotransporter-2 inhibitor (SGLT2i), glucagon-like peptide-1 receptor agonists (GLP-1RA), and other anti-hyperglycemic agents using indirect or direct comparison, above analyses showed conflicting results with each other. We aimed evaluate new-onset AF associated use SGLT2i, GLP-1RA, dipeptidyl peptidase-4 (DPP4i) among large longitudinal cohort diabetic patients. Methods In this nationwide retrospective study based on Taiwan National Health Insurance Research Database, total 344,893, 44,370, 393,100 consecutive patients type 2 diabetes without preexisting receiving DPP4i, respectively, enrolled from May 1, 2016, December 31, 2019. used 1:1 propensity score matching (PSM) balance covariates across paired groups. Patients followed drug index date until occurrence AF, death, discontinuation drug, end period (December 2020), whichever occurred first. Results After PSM, there 245,442, 43,682, 39,190 cohorts SGLT2i-DPP4i, SGLT2i-GLP-1RA, GLP-1RA-DPP4i, respectively. SGLT2i treatment was lower in participants compared either DPP4i [hazard ratio (HR):0.90; 95% confidential interval (CI) 0.84–0.96; P = 0.0028] GLP-1RA [HR 0.74; CI 0.63–0.88; 0.0007] after PSM. There no difference users 1.01; 0.86–1.19; 0.8980]. The findings persisted several important subgroups. Dapagliflozin specifically ( interaction 0.02). Conclusions Compared but not diabetes.