Decoding the effects of SGLT2 inhibitors on cardiac arrhythmias in heart failure
Abstract
This editorial refers to ‘Effect of dapagliflozin on ventricular arrhythmias, resuscitated cardiac arrest, or sudden death in DAPA-HF’, by J.P. Curtain et al., doi:10.1093/eurheartj/ehab560. Experimental design and major conclusions. Sodium–glucose co-transporter 2 inhibitors (SGLT2is), such as empagliflozin and dapagliflozin, have been developed as antidiabetic drugs that promote urinary excretion of glucose to improve glycaemic control.1 Surprisingly, recent large-scale cardiovascular (CV) safety trials demonstrate that SGLT2is significantly reduce the incidence of heart failure (HF) by 30–40% in diabetes patients.2–6 Furthermore, results from the EMPEROR-Reduced and DAPA-HF trials7–9 demonstrate that the marked cardioprotective effects of the SGLT2is are preserved in the absence of diabetes, suggesting protective mechanisms that are independent of improved glycaemic control. While the SGLT2i-mediated reduction in HF has understandably received the majority of attention, other signals such as reduction in sudden cardiac death (SCD) were also detected in these CV safety trials. These additional findings raise the possibility that SGLT2is may also possess an unexpected beneficial effect against ventricular arrhythmias which are one of the principal causes of SCD in patients with HF. Therefore, it is important to decode the trial data regarding any potential effects of the SGLTis on the incidence of ventricular arrhythmias. In this issue of the European Heart Journal, Curtain…
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