{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T22:47:26Z","timestamp":1790722046334,"version":"4.1.0"},"reference-count":63,"publisher":"American Medical Association (AMA)","issue":"10","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"<jats:sec id=\"ab-zoi221016-4\"><jats:title>Importance<\/jats:title><jats:p>Sodium-glucose cotransporter-2 inhibitors (SGLT-2is) have demonstrated many cardiovascular and kidney function benefits for patients with type 2 diabetes (T2D). However, the results of SGLT-2i use in primary prevention of atrial fibrillation (AF) were inconsistent in clinical trials, and incident AF was not a prespecified end point.<\/jats:p><\/jats:sec><jats:sec id=\"ab-zoi221016-5\"><jats:title>Objective<\/jats:title><jats:p>To examine incident AF with initiation of an SGLT-2i compared with initiation of a dipeptidyl peptidase-4 inhibitor (DPP-4i) or a glucagonlike peptide-1 receptor agonist (GLP-1RA) among older adults (aged \u226566 years) with T2D in routine clinical practice.<\/jats:p><\/jats:sec><jats:sec id=\"ab-zoi221016-6\"><jats:title>Design, Setting, and Participants<\/jats:title><jats:p>A population-based new-user cohort study included older adults with T2D who had no history of AF and were enrolled in Medicare fee-for-service from April 1, 2013, to December 31, 2018. Data analysis was performed from June 28 to December 1, 2021.<\/jats:p><\/jats:sec><jats:sec id=\"ab-zoi221016-7\"><jats:title>Exposures<\/jats:title><jats:p>To control for potential confounding, new users of SGLT-2i were 1:1 propensity score (PS)\u2013matched to new users of DPP-4is or GLP-1RAs in 2 pairwise comparisons based on 138 baseline covariates.<\/jats:p><\/jats:sec><jats:sec id=\"ab-zoi221016-8\"><jats:title>Main Outcomes and Measures<\/jats:title><jats:p>The primary outcome was incident AF, defined as an inpatient diagnosis code for AF. Hazard ratios (HRs) and rate differences (RDs) per 1000 person-years, with their 95% CIs, were estimated in the PS-matched groups.<\/jats:p><\/jats:sec><jats:sec id=\"ab-zoi221016-9\"><jats:title>Results<\/jats:title><jats:p>New users of SGLT-2is were 1:1 PS-matched to new users of a DPP-4i (n\u2009=\u200974\u202f868) or GLP-1RA (n\u2009=\u200980\u202f475). Overall, the mean (SD) age of study participants was 72 (5) years, and 165\u202f984 were women (53.4%). The risk of incident AF was lower in the SGLT-2i group than the matched DPP-4i group (HR, 0.82; 95% CI, 0.76 to 0.89; RD, \u20133.7; 95% CI, \u20135.2 to \u20132.2 per 1000 person-years) or the matched GLP-1RA group (HR, 0.90; 95% CI, 0.83 to 0.98; RD, \u20131.8; 95% CI, \u20133.2 to \u20130.3 per 1000 person-years). Results were consistent across several sensitivity and subgroup analyses.<\/jats:p><\/jats:sec><jats:sec id=\"ab-zoi221016-10\"><jats:title>Conclusions and Relevance<\/jats:title><jats:p>The findings of this study suggest that the initiation of an SGLT-2i was associated with a reduced risk of incident AF compared with a DPP-4i or GLP-1RA. The results may be helpful when weighing the potential risks and benefits of various glucose level\u2013lowering agents in older adults with T2D.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2022.35995","type":"journal-article","created":{"date-parts":[[2022,10,11]],"date-time":"2022-10-11T15:06:16Z","timestamp":1665500776000},"page":"e2235995","source":"Crossref","is-referenced-by-count":36,"title":["Association of Sodium-Glucose Cotransporter-2 Inhibitors With Incident Atrial Fibrillation in Older Adults With Type 2 Diabetes"],"prefix":"10.1001","volume":"5","author":[{"given":"Min","family":"Zhuo","sequence":"first","affiliation":[{"name":"Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women\u2019s Hospital, Boston, Massachusetts"},{"name":"Division of Renal Medicine, Brigham and Women\u2019s Hospital, Boston, Massachusetts"},{"name":"Department of Medicine, Brigham and Women\u2019s Hospital and Harvard Medical School, Boston, 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