Sodium‐glucose cotransporter 2 inhibitors: An additional management option for patients with atrial fibrillation?
Abstract
To meet the goal of obtaining antidiabetic medications that will have a favourable impact on the cardiovascular outcomes of patients with type 2 diabetes mellitus (T2DM), the sodium-glucose cotransporter (SGLT2) inhibitor class of drugs has emerged. The lesson learned in the past was to separate the mechanism of action of the new antidiabetic agents from insulin secretion and therefore avoid hypoglycaemic episodes, which are associated with aggressive control of glycaemic levels and have detrimental effects on cardiovascular health. Accordingly, SGLT2 inhibitors inhibit SGLT2-mediated glucose reabsorption at the level of the proximal convoluted tubule of the nephron, achieving steadier control of blood glucose levels. The four SGLT2 inhibitors currently licensed by the European Medicines Agency and the US Food and Drug Administration, empaglifozin, canagliflozin, dapagliflozin and ertugliflozin, have been tested in large clinical randomized controlled trials (RCTs): the EMPA-REG Outcome trial, CANVAS Program, DECLARE-TIMI 58 trial and VERTIS CV, respectively. All patients with T2DM and a high risk for cardiovascular disease achieved a significant reduction in hospitalization for heart failure. In addition, EMPA-REG Outcome also reported a significant reduction in cardiovascular mortality. Further extension of the findings of reduction in hospitalization and mortality to a population with heart failure, with or without T2DM, and with either preserved or reduced ejection…
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Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design.
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