Risk of cardiac death and heart failure Hypertrophic cardiomyopathy, suggesting the possibility of treatment of SGLT2 inhibitors
Dec 27, 2024
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Hypertrophic cardiomyopathy is a disease in which the heart muscle becomes abnormally thickened by more than 15mm, and is one of the representative hereditary heart diseases.
Genetic abnormalities are found in about 40% to 60% of patients, and family screening is important.
The disease increases the risk of arrhythmia, such as acute cardiac death, ventricular arrhythmia, and atrial fibrillation, and the risk of heart failure where the heart is not functioning normally can increase due to the decreased flexibility of the heart due to the thickened heart, which requires periodic follow-up.
Currently, the treatment of hypertrophic cardiomyopathy has mainly relied on common drugs such as beta blockers or calcium channel blockers. Recently, a myosin blocker specialized for hypertrophic cardiomyopathy has been introduced, but it is only limitedly used in obstructive hypertrophic cardiomyopathy.
Meanwhile, SGLT2 inhibitors (dapagliflozin, empagliflozin, etc.) have been proven to improve survival and reduce the risk of hospitalization due to worsening heart failure in heart failure patients, and are used as heart failure treatments regardless of diabetes. Some studies have also reported that SGLT2 inhibitors lower the risk of arrhythmia. However, because patients with hypertrophic cardiomyopathy were excluded from previous studies, the effect of SGLT2 inhibitors in hypertrophic cardiomyopathy was not known.
In response, a research team led by Professor Jeong Mi-hyang (first author) of the Department of Circulatory Medicine at Seoul St. Mary's Hospital and Professor Cho Jung-sun (corresponding author) of the Department of Cardiology at Daejeon St. Mary's Hospital tried to evaluate the effect of SGLT2 inhibitors on improving prognosis in patients with hypertrophic cardiomyopathy with diabetes using big data from the Health Insurance Corporation. Among a total of 8066 patients with hypertrophic cardiomyopathy and diabetes, we analyzed 2277 people who were prescribed SGLT2 inhibitors and 5,789 people who were prescribed other diabetes drugs. After reducing the heterogeneity of the two groups through 1:1 propensity score correction, follow-up observations were conducted for an average of 3.1 years based on data containing 2,063 people, respectively.
As a result, the use of SGLT2 inhibitors has been shown to reduce the risk of hospitalization due to all-cause death and worsening heart failure by approximately 24%.
Specifically, it reduced the risk of death from all causes by 44%, the risk of hospitalization for heart failure by 18%, the risk of sudden death by 50%, and the risk of stroke by 26%, respectively, and these effects were consistent regardless of gender and atrial fibrillation.
Professor Cho Jung-sun of Daejeon St. Mary's Hospital suggested the possibility that SGLT2 inhibitors contribute to reducing the risk of arrhythmia and heart failure in hypertrophic cardiomyopathy, where treatment options were limited", explaining the significance of the study.
Professor Jeong Mi-hyang of Seoul St. Mary's Hospital added, "However, since the causal relationship cannot be established by cohort studies, further studies are needed to support this, and follow-up studies are needed to confirm whether the same effect appears in patients with hypertrophic cardiomyopathy without diabetes."
He also emphasized that "the etiology of hypertrophic cardiomyopathy is gradually being revealed through genetic testing and multimodal evaluation including echocardiography and cardiac MRI recently, but there are still many unknowns, so it is a disease that requires continuous research and attention from researchers.".
The study was recently published in the European Journal of Preventive Cardiology.
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