New-onset syncope in diabetic patients treated with sodium-glucose cotransporter-2 inhibitors versus dipeptidyl peptidase-4 inhibitors: a Chinese population-based cohort study.

IF 5.3 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS
Xinyi Gao, Nan Zhang, Lei Lu, Tianyu Gao, Oscar Hou In Chou, Wing Tak Wong, Carlin Chang, Abraham Ka Chung Wai, Gregory Y H Lip, Qingpeng Zhang, Gary Tse, Tong Liu, Jiandong Zhou
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引用次数: 0

Abstract

Background and aims: Syncope is a symptom that poses an important diagnostic and therapeutic challenge, and generates significant cost for the healthcare system. Sodium-glucose cotransporter-2 inhibitors (SGLT2i) have demonstrated beneficial cardiovascular effects, but their possible effects on incident syncope have not been fully investigated. This study compared the effects of SGLT2i and dipeptidyl peptidase-4 inhibitors (DPP4i) on new-onset syncope.

Methods and results: This was a retrospective, territory-wide cohort study enrolling type 2 diabetes mellitus (T2DM) patients treated with SGLT2i or DPP4i between 1 January 2015 and 31 December 2020, in Hong Kong, China. The outcomes were hospitalization of new-onset syncope, cardiovascular mortality, and all-cause mortality. Multivariable Cox regression and different approaches using the propensity score were applied to evaluate the association between SGLT2i and DPP4i with incident syncope and mortality. After matching, a total of 37 502 patients with T2DM were included (18 751 SGLT2i users vs. 18 751 DPP4i users). During a median follow-up of 5.56 years, 907 patients were hospitalized for new-onset syncope (2.41%), and 2346 patients died from any cause (6.26%), among which 471 deaths (1.26%) were associated with cardiovascular causes. Compared with DPP4i users, SGLT2i therapy was associated with a 51% lower risk of new-onset syncope [HR 0.49; 95% confidence interval (CI) 0.41-0.57; P < 0.001], 65% lower risk of cardiovascular mortality (HR 0.35; 95% CI 0.26-0.46; P < 0.001), and a 70% lower risk of all-cause mortality (HR 0.30; 95% CI 0.26-0.34; P < 0.001) in the fully adjusted model. Similar associations with syncope were observed for dapagliflozin (HR 0.70; 95% CI 0.58-0.85; P < 0.001), canagliflozin (HR 0.48; 95% CI 0.36-0.63; P < 0.001), and ertugliflozin (HR 0.45; 95% CI 0.30-0.68; P < 0.001), but were attenuated for empagliflozin (HR 0.79; 95% CI 0.59-1.05; P = 0.100) after adjusting for potential confounders. The subgroup analyses suggested that, compared with DPP4i, SGLT2i was associated with a significantly decreased risk of incident syncope among T2DM patients, regardless of gender, age, glucose control status, Charlson comorbidity index, and the association remained constant amongst those with common cardiovascular drugs and most antidiabetic drugs at baseline.

Conclusion: Compared with DPP4i, SGLT2i was associated with a significantly lower risk of new-onset syncope in patients with T2DM, regardless of gender, age, degree of glycaemic control, and comorbidity burden.

钠-葡萄糖共转运蛋白-2抑制剂与二肽基肽酶-4抑制剂治疗糖尿病患者新发晕厥:一项基于中国人群的队列研究
背景和目的:晕厥是一种具有重要诊断和治疗挑战性的症状,并为医疗保健系统带来了巨大的成本。钠-葡萄糖共转运蛋白-2抑制剂(SGLT2i)已被证明对心血管有益,但其对偶发性晕厥的可能影响尚未得到充分研究。本研究比较了SGLT2i和二肽基肽酶-4抑制剂(DPP4i)对新发晕厥的作用。方法:这是一项回顾性的区域性队列研究,纳入了2015年1月1日至2020年12月31日在中国香港接受SGLT2i或DPP4i治疗的2型糖尿病(T2DM)患者。结果为新发晕厥住院、心血管死亡率和全因死亡率。采用多变量Cox回归和使用倾向评分的不同方法来评估SGLT2i和DPP4i与偶发性晕厥和死亡率之间的关系。结果:匹配后,共纳入37502例T2DM患者(18751例SGLT2i使用者与18751例DPP4i使用者)。在中位随访5.56年期间,907例患者因新发晕厥住院(2.41%),2346例患者因各种原因死亡(6.26%),其中471例死亡(1.26%)与心血管原因相关。与DPP4i使用者相比,SGLT2i治疗与新发晕厥风险降低51%相关(HR, 0.49;结论:与DPP4i相比,无论性别、年龄、血糖控制程度和合并症负担如何,SGLT2i与T2DM患者新发晕厥的风险显著降低相关。
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来源期刊
European Heart Journal - Cardiovascular Pharmacotherapy
European Heart Journal - Cardiovascular Pharmacotherapy Medicine-Cardiology and Cardiovascular Medicine
CiteScore
10.10
自引率
14.10%
发文量
65
期刊介绍: The European Heart Journal - Cardiovascular Pharmacotherapy (EHJ-CVP) is an international, peer-reviewed journal published in English, specifically dedicated to clinical cardiovascular pharmacology. EHJ-CVP publishes original articles focusing on clinical research involving both new and established drugs and methods, along with meta-analyses and topical reviews. The journal's primary aim is to enhance the pharmacological treatment of patients with cardiovascular disease by interpreting and integrating new scientific developments in this field. While the emphasis is on clinical topics, EHJ-CVP also considers basic research articles from fields such as physiology and molecular biology that contribute to the understanding of cardiovascular drug therapy. These may include articles related to new drug development and evaluation, the physiological and pharmacological basis of drug action, metabolism, drug interactions, and side effects.
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