Impact of Sodium-Glucose Cotransporter 2 Inhibitors on Clinical Outcomes in Patients with Hypertrophic Cardiomyopathy
S Shin, D Y Kim, J H Jang, S K RyuAbstract
Background
Sodium–glucose cotransporter-2 (SGLT2) inhibitors have demonstrated clinical benefits in heart failure (HF) across a broad spectrum of ejection fraction and diabetes status. However, evidence regarding their effectiveness in hypertrophic cardiomyopathy (HCM) remains limited.
Purpose
We aimed to evaluate the association between SGLT2 inhibitors use and clinical outcomes in a nationwide HCM cohort, including those without diabetes.
Methods
We conducted a retrospective cohort study using the National Health Insurance Service database. A total of 5,312 patients with HCM (mean age 65 ±14 years; female 39%; diabetes 80%; obstructive type 10%) were identified and matched in a 1:1 ratio by propensity score with 35 baseline variables. The primary outcome was a composite of all-cause mortality or HF hospitalization. Secondary outcomes included all-cause mortality, HF hospitalization, stroke, and myocardial infarction (MI).
Results
Over a median follow-up of 5.1 years, patients on SGLT2 inhibitors were associated with a lower risk of hospitalizations for HF or mortality compared to those not on SGLT2 inhibitors (HR 0.80, 95% CI 0.71-0.90, P<0.001, Figure). This reduction was primarily driven by a decrease in HF hospitalization (HR 0.79, 95% CI 0.70-0.89; P<0.001). SGLT2 inhibitor use was also associated with a lower risk of stroke (HR 0.51; 95% CI 0.40-0.65; P<0.001), but not of mortality (HR 1.39, 95% CI 0.89-2.18; P=0.15) or MI (HR 0.76. 95% CI 0.57-1.01; P=0.063). The reduction in the primary endpoint was consistent irrespective of diabetic status and obstructive phenotype (P for interaction=0.39 for diabetes; 0.18 for obstructive type).
Conclusion
In a nationwide cohort of patients with HCM, SGLT2 inhibitor was associated with a lower risk of a composite end-point of mortality and HF hospitalization, with consistent effects across diabetic and non-diabetic patients and across HCM subtypes. These findings suggest potential clinical benefit of SGLT2 inhibitors in a broader HCM population.KM Curves for Outcomes by SGLT2i in HCM