{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T16:15:09Z","timestamp":1790957709184,"version":"4.1.0"},"reference-count":31,"publisher":"Public Library of Science (PLoS)","issue":"2","license":[{"start":{"date-parts":[[2025,2,7]],"date-time":"2025-02-07T00:00:00Z","timestamp":1738886400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100002635","name":"Inha University","doi-asserted-by":"publisher","award":["Inha 70431"],"award-info":[{"award-number":["Inha 70431"]}],"id":[{"id":"10.13039\/501100002635","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Sodium glucose cotransporter 2 (SGLT2) inhibitors improve clinical outcomes in several populations including type 2 diabetes (T2D), chronic renal insufficiency, and heart failure (HF). However, limited data exist on their effects on atrial fibrillation (AF).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>We conducted a retrospective cohort study using the National Health Insurance Service database. A total of 4,771 patients with T2D and AF who were newly prescribed SGLT2 inhibitors or DPP4 inhibitors were selected and matched in a 1:2 ratio by propensity score with 37 confounding variables. We assessed the effect of SGLT2 inhibitors on the composite outcome of either HF hospitalization or death.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Over a median follow-up of 31 months, patients on SGLT2 inhibitors were associated with a lower risk of hospitalizations for HF or mortality compared to those on DPP4 inhibitors (HR 0.61; 95% CI 0.44\u20130.85; P = 0.004). SGLT2 inhibitor use was also associated with a lower risk of mortality (HR 0.61; 95% CI 0.39\u20130.94; P = 0.025) and CV mortality (HR 0.43; 95% CI 0.21\u20130.86; P = 0.018), but not of MI (HR 1.22 [95% CI 0.72\u20132.09]; P = 0.461) or stroke (HR 1.00 [95% CI 0.75\u20131.33]; P = 0.980). The incidence of hospitalizations for HF, although statistically insignificant, tended to be lower in the SGLT2 inhibitor group (HR 0.63 [95% CI 0.39\u20131.02]; P = 0.062).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>In a nationwide cohort of patients with T2D and AF, SGLT2 inhibitor was associated with a lower risk of mortality, which may suggest that SGLT2 inhibitors may be considered as the first-line antidiabetic medication in patients with T2D and AF.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0314454","type":"journal-article","created":{"date-parts":[[2025,2,7]],"date-time":"2025-02-07T18:22:22Z","timestamp":1738952542000},"page":"e0314454","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":5,"title":["The effect of SGLT2 inhibitor in patients with type 2 diabetes and atrial fibrillation"],"prefix":"10.1371","volume":"20","author":[{"given":"Yongin","family":"Cho","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8306-9622","authenticated-orcid":true,"given":"Sung-Hee","family":"Shin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Min-Ae","family":"Park","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Young Ju","family":"Suh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6019-6912","authenticated-orcid":true,"given":"Sojeong","family":"Park","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ji-Hun","family":"Jang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dae-Young","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"So Hun","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,2,7]]},"reference":[{"key":"pone.0314454.ref001","doi-asserted-by":"crossref","first-page":"e125","DOI":"10.1161\/CIR.0000000000000665","article-title":"2019 AHA\/ACC\/HRS focused update of the 2014 AHA\/ACC\/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology\/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society in collaboration with the Society of Thoracic Surgeons","volume":"140","author":"CT January","year":"2019","journal-title":"Circulation"},{"key":"pone.0314454.ref002","doi-asserted-by":"crossref","first-page":"1555","DOI":"10.1177\/2047487317715769","article-title":"Atrial fibrillation and the risk for myocardial infarction, all-cause mortality and heart failure: a systematic review and meta-analysis","volume":"24","author":"V Ruddox","year":"2017","journal-title":"European journal of preventive cardiology"},{"key":"pone.0314454.ref003","first-page":"447","article-title":"Heart failure and atrial fibrillation, like fire and fury","volume":"7","author":"MA Carlisle","year":"2019","journal-title":"JACC: Heart 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nationwide population-based cohort study","volume":"17","author":"Y-G Kim","year":"2018","journal-title":"Cardiovascular diabetology"},{"key":"pone.0314454.ref010","doi-asserted-by":"crossref","first-page":"e13145","DOI":"10.1111\/eci.13145","article-title":"Understanding of interaction (subgroup) analysis in clinical trials","volume":"49","author":"M Brankovic","year":"2019","journal-title":"European journal of clinical investigation"},{"key":"pone.0314454.ref011","first-page":"1","article-title":"The risk of new-onset atrial fibrillation in patients with type 2 diabetes mellitus treated with sodium glucose cotransporter 2 inhibitors versus dipeptidyl peptidase-4 inhibitors","volume":"19","author":"AW-C Ling","year":"2020","journal-title":"Cardiovascular Diabetology"},{"key":"pone.0314454.ref012","doi-asserted-by":"crossref","first-page":"417","DOI":"10.4093\/dmj.2022.0106","article-title":"Diabetes fact sheet in Korea 2021","volume":"46","author":"JH Bae","year":"2022","journal-title":"Diabetes & Metabolism Journal"},{"key":"pone.0314454.ref013","doi-asserted-by":"crossref","first-page":"232","DOI":"10.1056\/NEJMoa1501352","article-title":"Effect of sitagliptin on cardiovascular outcomes in type 2 diabetes","volume":"373","author":"JB Green","year":"2015","journal-title":"New England Journal of Medicine"},{"key":"pone.0314454.ref014","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1001\/jama.2018.18269","article-title":"Effect of linagliptin vs placebo on major cardiovascular events in adults with type 2 diabetes and high cardiovascular and renal risk: the CARMELINA randomized clinical trial","volume":"321","author":"J Rosenstock","year":"2019","journal-title":"Jama"},{"key":"pone.0314454.ref015","doi-asserted-by":"crossref","first-page":"S140","DOI":"10.2337\/dc23-S009","article-title":"9. 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cardiovascular outcomes in patients with type 2 diabetes mellitus","volume":"369","author":"BM Scirica","year":"2013","journal-title":"New England Journal of Medicine"},{"key":"pone.0314454.ref031","doi-asserted-by":"crossref","first-page":"2067","DOI":"10.1016\/S0140-6736(14)62225-X","article-title":"Heart failure and mortality outcomes in patients with type 2 diabetes taking alogliptin versus placebo in EXAMINE: a multicentre, randomised, double-blind trial","volume":"385","author":"F Zannad","year":"2015","journal-title":"The Lancet"}],"container-title":["PLOS 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