Impact of SGLT2 Inhibitors on Outcomes in Diabetic Patients with Hypertrophic Cardiomyopathy

Overview

In a Korean population-based cohort study of 4,126 patients with hypertrophic cardiomyopathy (HCM) and diabetes, use of sodium–glucose cotransporter-2 inhibitors (SGLT2i) was associated with significantly reduced risks of all-cause death, heart failure hospitalization, sudden cardiac death, and ischemic stroke over a median follow-up of 3.1 years. These benefits were consistent across subgroups defined by age, sex, and atrial fibrillation status.

Background

Hypertrophic cardiomyopathy is a common inheritable heart disease characterized by myocardial thickening and fibrosis, leading to risks of heart failure and fatal arrhythmias. Despite advances, treatment options remain limited, especially for patients with concurrent diabetes. Sodium–glucose cotransporter-2 inhibitors have demonstrated mortality and morbidity benefits in heart failure populations but have not been extensively studied in HCM. This study aimed to evaluate the real-world impact of SGLT2i on clinical outcomes in patients with HCM and diabetes.

Data Highlights

Key Findings

• SGLT2i use was associated with a 24% reduction in the risk of the composite primary outcome of all-cause death and heart failure hospitalization.
• All-cause mortality was reduced by 44% in patients treated with SGLT2i compared to non-users.
• Heart failure hospitalization risk decreased by 18% among SGLT2i users.
• Sudden cardiac death risk was halved in the SGLT2i group, indicating a significant protective effect against fatal arrhythmias.
• Ischaemic stroke incidence was reduced by 26% in patients receiving SGLT2i therapy.
• These associations were consistent across subgroups stratified by age, sex, and presence of atrial fibrillation, with no significant interactions observed.

Clinical Implications

SGLT2 inhibitors may offer a valuable therapeutic option to reduce mortality, heart failure hospitalizations, and arrhythmic events in patients with hypertrophic cardiomyopathy and diabetes. Clinicians should consider incorporating SGLT2i into the management of this high-risk population, especially given the limited treatment options currently available for HCM. These findings support further prospective studies and may inform guideline updates.

Conclusion

In patients with hypertrophic cardiomyopathy and diabetes, SGLT2 inhibitor use is associated with significant reductions in mortality, heart failure hospitalization, sudden cardiac death, and ischemic stroke. This real-world evidence highlights the potential of SGLT2i to improve clinical outcomes in this challenging patient population.

References

1. Korean National Health Insurance Service Database Study 2018-2022 -- Impact of SGLT2 Inhibitors on Clinical Outcomes in Diabetic Patients with Hypertrophic Cardiomyopathy