Effect of Sodium-Glucose Cotransporter-2 Inhibitors on the Progression of Aortic Stenosis

IF 11.7 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Cardiovascular interventions Pub Date : 2025-03-24 DOI:10.1016/j.jcin.2024.11.036

Tayyab Shah MD , Zhiyuan Zhang MD, MPH , Haashim Shah BA , Alexander C. Fanaroff MD, MHS , Ashwin S. Nathan MD, MS , Helen Parise ScD , John Lutz MA , Lissa Sugeng MD, MPH , Lavanya Bellumkonda MD , Björn Redfors MD, PhD , Elmir Omerovic MD, PhD , Mark C. Petrie MD , Amit N. Vora MD, MPH , Paul N. Fiorilli MD , Taisei Kobayashi MD , Yousif Ahmad MD, PhD , John K. Forrest MD , Jay S. Giri MD, MPH , Howard C. Herrmann MD , Alexandra J. Lansky MD

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引用次数: 0

Abstract

Background

Aortic stenosis (AS) is the leading cause of valvular heart disease-related morbidity and mortality, but there are no medical treatments to slow its progression. Sodium-glucose cotransporter-2 inhibitors (SGLT2i) have pleiotropic effects which could be disease modifying in AS.

Objectives

The purpose of this study was to determine if SGLT2i usage is associated with slower progression of AS.

Methods

A target trial emulation comparing the effect of the initiation of SGLT2i compared with no SGLT2i in patients with nonsevere AS was performed using retrospective electronic medical record data from the Yale New Haven Health System from January 2016 to September 2022. Patients with native aortic valve sclerosis or nonsevere AS with at least 12 months of echocardiographic follow-up were included. Patients were excluded if they had an estimated glomerular filtration rate <30 mL/min/1.73 m² or had initiated SGLT2i >1 year before the index echocardiogram. The prespecified primary outcome was progression to severe AS.

Results

A total of 458 patients prescribed SGLT2i and 11,240 patients never prescribed SGLT2i were included. Patients were on SGLT2i for a median of 0.9 years. Patients on SGLT2i were younger and had higher rates of diabetes and chronic kidney disease. Patients on SGLT2i were more likely to have ejection fraction ≤40%. There were no differences between groups in baseline AS severity (66% sclerosis, 23% mild stenosis, and 11% moderate in overall cohort). Patients ever prescribed SGLT2i were less likely to progress to severe AS (HR: 0.61; 95% CI: 0.39-0.94; P = 0.03) with a progressively lower risk among patients on SGLT2i for >3, 6, and 12 months (HR: 0.54, 0.48, and 0.27, respectively).

Conclusions

This retrospective, multicenter, observational study suggests that SGLT2i may slow the progression of nonsevere AS.

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来源期刊

JACC. Cardiovascular interventions CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

11.60

自引率

8.80%

发文量

756

审稿时长

4-8 weeks

期刊介绍： JACC: Cardiovascular Interventions is a specialist journal launched by the Journal of the American College of Cardiology (JACC). It covers the entire field of interventional cardiovascular medicine, including cardiac, peripheral, and cerebrovascular interventions. The journal publishes studies that will impact the practice of interventional cardiovascular medicine, including clinical trials, experimental studies, and in-depth discussions by respected experts. To enhance visual understanding, the journal is published both in print and electronically, utilizing the latest technologies.