Reduced Incidence of Aortic Dissection in Patients With Type 2 Diabetes Treated With Sodium Glucose Transporter 2 Inhibitors.

Background: Inhibitors for sodium-glucose transport protein 2 (SGLT2) are being used widely in recent years to treat patients with type 2 diabetes (T2D). Studies demonstrated that SGLT2 inhibitors exhibit protective effect for certain cardiovascular diseases. However, no study has explored the effect of SGLT2 inhibitors on risk of aortic dissection in patients with T2D.

Methods: We extracted and retrospectively analyzed the data of all patients with T2D from Taiwan National Health Institution databases between May 1, 2016, and December 31, 2021. Patients with T2D taking DPP4 (dipeptidyl peptidase 4) inhibitors were included for comparison to exclude glucose lowering effect on aortic dissection. In this cohort, 242 563 patients received SGLT2 inhibitors (T2D-SGLT2i), and 376 062 patients received DPP4 inhibitors (T2D-DPP4i). The inverse probability of treatment weighting statistical method was performed, which avoids sample loss due to matching. The hazard ratios (HRs) and 95% CIs for these patients with T2D were calculated using multivariate Cox models to approximate the associations.

Results: The overall aortic dissection incidence per 100 000 patient-years was 14.83 for patients with T2D-SGLT2i and 29.56 for patients with T2D-DPP4i. Patients with T2D-SGLT2i were associated with a lower risk of aortic dissection as compared with patients with T2D-DPP4i after the adjustment of potential risk factors and comorbidity. Subgroup analysis indicated that use of SGLT2 inhibitor lowers the risk of aortic dissection in some subgroups of patients with T2D.

Conclusions: Our study suggested that use of SGLT2 inhibitors correlated with lower risk of aortic dissection.