Sodium-glucose cotransporter 2 inhibitors (SGLT2i) could have a therapeutic benefit for patients with transthyretin amyloid cardiomyopathy (ATTR-CM), according to a brief report recently published in JACC: Advances.
Researchers observed that after one year, patients taking SGLT2i had a 49% lower risk of all-cause mortality (ACM), a 45% lower risk of major adverse cardiovascular events (MACE) and a 36% lower risk of ischemic stroke. The trends persisted over the following three years.
What is ATTR-CM?
Transthyretin amyloidosis cardiomyopathy (ATTR-CM) is a rare progressive disease of the heart muscle that leads to congestive heart failure. It occurs when the transthyretin protein produced by the liver is unstable. Symptoms include fatigue; shortness of breath; irregular heart rate or palpitations; swelling of the legs, ankles and stomach; brain fog; wheezing; and dizziness. It often goes underdiagnosed because of a lack of awareness and knowledge of the disease. There is currently no cure for ATTR-CM.
“SGLT2i is associated with reduced ACM, MACE, and ischemic stroke in patients with ATTR-CM, without increasing the risk of ” heart failure, atrial fibrillation, and ventricular tachycardia, the authors said.
Read more about ATTR-CM therapies
The authors analyzed a large retrospective study that used the TriNetX database to include 2,417 patients previously diagnosed with ATTR-CM and receiving treatment with SGLT2i to compare their outcomes to 32,860 patients not receiving the drugs.
Following propensity score matching, researchers evaluated the risks of all-cause mortality, major adverse cardiovascular events, ischemic stroke, heart failure, atrial fibrillation and ventricular tachycardia over periods of one month, one year and three years.
After one year, patients taking SGLT2i had a 49% lower risk of all-cause mortality, a 45% lower risk of major adverse cardiovascular events and a 36% lower risk of ischemic stroke; these trends persisted over the following three years, researchers found.
Researchers did not observe any significant differences between the SGLT2i and control groups for heart failure, atrial fibrillation or ventricular tachycardia risks, reflecting the complex nature of ATTR-CM and its predisposition to cardiac-related morbidity.
“These findings are particularly encouraging given the emerging disease-modifying treatments for this condition, indicating that SGLT2i may effectively complement these new therapeutic options,” the authors said.
SLGLT2i drugs were initially intended to treat patients with Type 2 diabetes mellitus as they inhibit glucose reabsorption in the kidney. Subsequent research showed they also have beneficial effects in cardiovascular disease, such as decreased blood pressure.
Another key feature of the drugs is that SGLT2i do not exacerbate hemodynamic instability, unlike traditional heart failure treatments, making them a suitable option for advanced stages of ATTR-CM.
Several studies have proved that SGLT2i administration reduces the risk of major cardiovascular events, heart failure hospitalizations and all cause mortality in patients with heart failure. But patients with ATTR-CM were often not included in these studies.
Researchers attributed the benefits of SGLT2i drugs in ATTR-CM to their multifaceted cardiovascular effects, including reduced myocardial inflammation and scarring, enhanced cardiac energy efficiency and diuretic properties that mitigate fluid overload.
