Impact of sodium-glucose cotransporter-2 inhibitors on clinical outcomes in patients with valvular heart diseases and type 2 diabetes
D Kim, S K Ryu, J H Jang, S H ShinAbstract
Background
Valvular heart disease (VHD) is associated with adverse clinical outcomes, including an increased risk of heart failure (HF), stroke, and mortality. Sodium–glucose cotransporter-2 (SGLT2) inhibitors have shown significant benefits in patients with type 2 diabetes, HF, and chronic kidney disease (CKD). However, evidence regarding their clinical impact in patients with VHD remains limited.
Purpose
We aimed to evaluate the association between SGLT2 inhibitor use and clinical outcomes in patients with VHD and type 2 diabetes.
Methods
Using the Korean National Health Insurance Service database, we identified patients diagnosed with both VHD and type 2 diabetes. After excluding patients with type 2 diabetes diagnosed prior to VHD, prior use of any antidiabetic medication, CKD stage ≥4, or a history of cancer, a total of 28,561 patients were included. Patients were subsequently propensity score–matched in a 1:1 ratio between those treated with SGLT2 inhibitors and those receiving other antidiabetic medications using 30 covariates, resulting in 5,293 patients in each group for the final analysis (Figure 1). The primary outcome was a composite of all-cause mortality, hospitalization for HF, myocardial infarction (MI), and stroke.
Results
During a median follow-up of 27 months, the composite outcome occurred in 3,601 patients (34%), including all-cause mortality (4%), hospitalization for HF (30%), MI (5%), and stroke (7%). Patients on SGLT2 inhibitors were associated with a significantly lower risk of the composite outcome compared with those receiving other antidiabetic medications (hazard ratio (HR) 0.86; 95% confidence interval (CI) 0.80–0.93; p<0.001). This association was particularly evident for hospitalization for HF (HR 0.88; 95% CI 0.82–0.96; p=0.003) and stroke (HR 0.73; 95% CI 0.61–0.87, p<0.001) (Figure 2).
Conclusion
In this nationwide cohort of patients with VHD and type 2 diabetes, treatment with SGLT2 inhibitors was significantly associated with a lower risk of adverse clinical outcomes, particularly HF hospitalization and stroke. These finding might suggest that SGLT2 inhibitor may be considered a favorable therapeutic option in this high risk population.For image description, please refer to the figure legend and surrounding text.For image description, please refer to the figure legend and surrounding text.