Introduction: Numerous trials have studied the effects of sodium-glucose cotransporter-2 inhibitors (SGLT2Is) on ventricular tachycardia/fibrillation (VT/VF) or sudden cardiac death (SCD), with conflicting findings. However, this has not been explored in population-based real-world studies. We compared the risks of VT/VF/SCD between SGLT2I and dipeptidyl peptidase-4 inhibitors (DPP4Is) in a Chinese population.
Methods: The was a retrospective cohort study of SGLT2I/DPP4I users between 1 January 2015 and 31 December 2019 in public hospitals, outpatient/ambulatory care facilities in Hong Kong. The primary outcome was VT/VF/SCD with follow-up until 31 December 2019. Propensity score matching with nearest neighbour search (1:1), inverse probability treatment weighting (IPTW), propensity score stratification and high-dimensional propensity score (HDPS) adjustments were used.
Results: A total of 69,128 patients (median age: 65.5 years [standard deviation (SD): 12.9], 55.5% males; 28,678 SGLT2I vs 40,450 DPP4I users) were included. After matching for demographics, comorbidities, anti-diabetic and cardiovascular drugs, fasting glucose and HbA1c, 100 patients (incidence rate [IR]: 0.46%) developed VT/VF/SCD, with significant difference between SGLT2I (21/10,766; IR: 0.19%) and DPP4I (79/10,766, IR: 0.73%) users (p<0.001). Cox regression showed that SGLT2I use was associated with lower risks of VT/VF/SCD compared with DPP4I use (hazard ratio [HR] 0.43, 95% confidence interval [CI] 0.26–0.70; p<0.0007). IPTW (HR 0.42, 95% CI 0.33–0.71; p<0.0001), propensity score stratification (HR 0.46, 95% CI 0.31–0.65; p<0.0001) and HDPS adjustment (HR 0.43, 95% CI 0.30–0.69; p<0.0001) produced similar results.
Conclusions and implications: SGLT2I use was significantly associated with lower risks of VT/VF/SCD compared with DPP4I use amongst patients with type 2 diabetes mellitus. ❑