SGLT2 inhibitors after TAVR may boost survival, limit bioprosthetic valve dysfunction
Treatment with sodium–glucose cotransporter 2 (SGLT2) inhibitors may provide significant value for patients undergoing transcatheter aortic valve replacement (TAVR), according to new data published in the Journal of Clinical Medicine.[1]
“Mechanistic studies suggest that SGLT2 inhibition may attenuate oxidative stress, improve endothelial function, suppress proinflammatory signaling, and reduce fibrotic remodeling—key mechanisms implicated in bioprosthetic valve failure,” wrote first author Olivier Morel, MD, PhD, a cardiologist with Strasbourg University Hospital and the University of Strasbourg, and colleagues. “These effects may be particularly relevant in the context of TAVR, where the native valve remains in situ, potentially interacting with the implanted prosthesis. Given these mechanistic insights, we sought to determine whether SGLT2 inhibitor use is associated with improved clinical outcomes after TAVR.”
The group explored data from nearly 27,000 adults with severe aortic stenosis who underwent TAVR in one of 18 different countries. Outcomes were assessed over a mean follow-up period of 1.4 years.
Overall, 8.8% of patients received SGLT2 inhibitor therapy when they underwent TAVR. Propensity score matching was used to focus on two comparable groups of 2,297 patients. The annual mortality rates were 7.5% for the SGLT2 group and 8.6% for the non-SGLT2 group. In addition, the annual bioprosthetic valve failure rates were 0.75% for the SGLT2 group and 1.3% for the non-SGLT2 group. The atrial fibrillation rate was also lower among SGLT2 inhibitor patients, but not enough to be considered statistically significant.
Meanwhile, no significant differences were seen when it came to thrombotic events, major bleeding events, renal dysfunction, endocarditis or heart failure.
“These findings suggest a potential disease-modifying role for SGLT2 inhibitors in this population,” the authors wrote.
The group did note that their study was both retrospective and observational, making it impossible to make “definite conclusions about causality.” The authors called for additional research on this topic.
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Michael has more than 19 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.