Impact of empagliflozin and dapagliflozin on sudden cardiac death: A systematic review and meta-analysis of adjudicated randomized evidence.
Andrea Matteucci, Claudio Pandozi, Michela Bonanni et al.
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In 30 seconds
This systematic review and meta-analysis assessed sudden cardiac death (SCD) with empagliflozin or dapagliflozin in people with type 2 diabetes, heart failure, or chronic kidney disease. It pooled randomized controlled trial evidence from 8 trials involving 58,569 participants, with a median follow-up of 29 months. SGLT2 inhibitor treatment was associated with lower odds of SCD than placebo (odds ratio: 0.82; 95% confidence interval: 0.72-0.94; P = .0104). Subgroup estimates were not statistically significant, and the authors call for trials designed specifically to assess adjudicated arrhythmic outcomes.
Key findings
- Across 8 randomized trials, SGLT2 inhibitors were associated with lower SCD odds than placebo (odds ratio: 0.82; 95% confidence interval: 0.72-0.94; P = .0104).
- The pooled analysis showed negligible heterogeneity (I 2 = 0.0%).
- Subgroup-specific estimates by age, follow-up duration, population, and inhibitor type did not reach statistical significance.
Why it matters
SCD is an important cardiovascular outcome, and this pooled randomized evidence suggests a possible reduction with empagliflozin or dapagliflozin across cardio-renal-metabolic populations. The result adds to assessment of SGLT2 inhibitor cardiovascular effects, but subgroup findings were inconclusive and the analysis does not establish an anti-arrhythmic mechanism.
What to keep in mind
The analysis pooled trials not described as specifically designed to assess arrhythmic endpoints; the authors state that dedicated trials with pre-adjudicated arrhythmic outcomes are warranted.