GLP-1薬が心房細動患者の予後を改善（For Patients with Afib and Type 2 Diabetes, GLP-1 Drugs Outperform SGLT-2 Drugs）

2026-07-01 バッファロー大学（UB）

＜関連情報＞

• https://www.buffalo.edu/news/releases/2026/06/Afib-diabetes-drug-study.html
• https://www.sciencedirect.com/science/article/abs/pii/S0168822726002664

2型糖尿病および心房細動を有する成人におけるグルカゴン様ペプチド-1受容体作動薬とナトリウム-グルコース共輸送体-2阻害薬の比較：心血管および不整脈アウトカムに関する多施設共同比較有効性コホート研究 Glucagon-like peptide-1 receptor agonists versus sodium-glucose cotransporter-2 inhibitors in adults with type 2 diabetes and atrial fibrillation: a multicenter comparative effectiveness cohort study of cardiovascular and arrhythmic outcomes

Md.Mohaimenul Islam, Arinze Nkemdirim Okere
Diabetes Research and Clinical Practice  Available online: 28 May 2026
DOI:https://doi.org/10.1016/j.diabres.2026.113346

Highlights:

• Adults with AF and T2D experienced 36% lower mortality with GLP-1RA than SGLT-2i.
• The benefit extended across hospitalization, cardiovascular events, and kidney injury.
• GLP-1RA was uniquely linked to a more favorable atrial fibrillation disease course.
• No significant interactions were observed across age or body mass index strata.
• Findings may inform individualized cardiometabolic therapy selection in patients with concurrent AF and T2D.

Abstract

Aims

To compare glucagon-like peptide-1 receptor agonists (GLP-1RA) with sodium-glucose cotransporter-2 inhibitors (SGLT-2i) for cardiovascular, atrial fibrillation (AF) disease course, and safety outcomes in adults with concurrent AF and type 2 diabetes.

Methods

Retrospective propensity-score-matched cohort study using the TriNetX Research Network (2016 – 2024). A new-user, active-comparator design identified adults with concurrent AF and type 2 diabetes initiating GLP-1RA or SGLT-2i. Patients were 1:1 matched on demographic, clinical, laboratory, and medication covariates. Hazard ratios (HRs) were estimated using Cox proportional hazards regression. The Benjamini–Hochberg procedure controlled the false discovery rate, and E-values quantified robustness to unmeasured confounding.

Results

After matching, 18,035 GLP-1RA users were compared with 18,035 SGLT-2i users (mean age 67.4 years; 52.2% male, 47.8% female). At 365 days, GLP-1RA was associated with lower all-cause mortality (HR 0.64, 95% CI 0.57 – 0.71), hospitalization (0.88, 0.84 – 0.92), 3-point MACE (0.78, 0.71 – 0.86), AF progression (0.94, 0.90 – 0.98), AF ablation (0.81, 0.70 – 0.94), and cardioversion (0.79, 0.70 – 0.90). Effects were consistent across age and body mass index subgroups. E-values ranged 1.5 – 2.5.

Conclusion

Over 1 year, GLP-1RA initiation was associated with lower risks of mortality, hospitalization, atherosclerotic events, and adverse AF disease-course outcomes than SGLT-2i in adults with concurrent AF and T2D, with the established SGLT-2i benefits for heart failure and CKD remaining the basis for class choice in those subpopulations.