Abstract
Type 2 diabetes (T2D) is an independent risk factor for the development of atrial fibrillation (AF). Recently, Sodium-glucose cotransporter-2 inhibitor(SGLT-2i) has been shown to decrease the incidence of AF through several mechanisms including reduction of atrial dilatation via diuresis and lowering body weight. On the other hand, the use of thiazolidinedione (TZD) was found protecting effect on new-onset AF in diabetic patients in observational studies. We aimed to compare the effect on risk of AF with SGLT2 inhibitor and TZD in patients with type 2 diabetes (T2D). We enrolled 69,122 patients who has newly prescribed with SGLT-2i and 94,262 patients prescribed with TZD from January 2014 to December 2018, using the Korean National Health Insurance Service database. We compared new onset AF event (hospitalization and outpatient event) in SGLT-2i and TZD groups after taking medicine more than 90days After propensity score matching (each group n=54,993), 397 (0.72%) of new onset AF events were occured in SGLT-2i group and 432 (0.79%) events in TZD group during a mean follow-up of 1.8 years. The hazard ratio (HR) of AF was 0.918 (95% confidence interval : 0.783-1.076, p = 0.29) in SGLT-2i treated patients compared with TZD-treated patients. In this study, the risk of new onset AF was comparable in patients treated with SGLT-2i and TZD in T2D. Both SGLT-2i and TZD would be a reasonable choice in patients with T2D who are at risk for AF development.
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