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Antidiabetic drugs for preventing atrial fibrillation: A new revolution?

      Type 2 diabetes mellitus (DM) and atrial fibrillation (AF) are 2 of the great epidemics of our time. DM affects an estimated 8.5% of adults in the United States
      • Xu G.
      • Liu B.
      • Sun Y.
      • et al.
      Prevalence of diagnosed type 1 and type 2 diabetes among US adults in 2016 and 2017: population based study.
      and is associated with an increased risk of cardiovascular events, including AF.
      • Huxley R.R.
      • Filion K.B.
      • Konety S.
      • Alonso A.
      Meta-analysis of cohort and case-control studies of type 2 diabetes mellitus and risk of atrial fibrillation.
      AF in turn affects up to an estimated 12.5% of adults older than 65 years in the United States, decreases quality of life, and increases the risks of heart failure, stroke, and death.
      • Wolf P.A.
      • Abbott R.D.
      • Kannel W.B.
      Atrial fibrillation as an independent risk factor for stroke: the Framingham Study.
      ,
      • Hindricks G.
      • Piorkowski C.
      • Tanner H.
      • et al.
      Perception of atrial fibrillation before and after radiofrequency catheter ablation: relevance of asymptomatic arrhythmia recurrence.
      In 2015, the EMPA-REG OUTCOME (BI 10773 [Empagliflozin] Cardiovascular Outcome Event Trial in Type 2 Diabetes Mellitus Patients) randomized controlled trial (RCT), which assessed the sodium glucose cotransporter 2 inhibitor SGLT-2i, sparked interest in the therapeutic potential of oral antidiabetic agents in reducing cardiovascular outcomes.
      • Zinman B.
      • Wanner C.
      • Lachin J.M.
      • et al.
      Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes.
      Since then, several other SGLT-2i trials have shown consistent reductions in heart failure hospitalizations, cardiovascular death, and/or major adverse cardiovascular outcomes compared to placebo.
      • Wence S.
      • Wenchang Z.
      • Da Z.
      • et al.
      Comparison of the effect of glucose-lowering agents on the risk of atrial fibrillation: a network meta-analysis.
      However, the impact of SGLT-2is and other oral antidiabetic agents on AF is less clear.
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