A large-scale study of 10,852 patients with ATTR-CM found that sodium glucose co-transporter 2 inhibitors (SGLT2is) are associated with lower mortality and hospitalizations in patients with transthyretin amyloid cardiomyopathy (ATTR-CM). Findings were published in JACC: Advances.
Overall, individuals receiving SGLT2is had a 56% lower risk of all-cause mortality than those not receiving the therapy. In addition, those taking SGLT2is had a 38% lower rate of heart failure hospitalization at any point during follow-up.
SGLT2is are often used in patients with heart failure, diabetes and kidney disease. Although research has already established that SGLT2is reduce the risk of mortality and hospitalization among those with heart failure, patients with ATTR-CM and similar conditions were underrepresented in these studies.
The meta-analysis compiled data from 14 studies including adults with ATTR-CM who received SGLTI2i therapy. Of the 10,852 participants, 5,453 (50.2%) received SLGT2is, with follow-up ranging from three months to 5.5 years.
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Analysis of safety outcomes revealed a prevalence of adverse events of 7.28%. Common side effects included infections in the reproductive and urinary systems, low blood pressure and acute kidney injury. The authors noted, however, that the prevalence of adverse events varied widely across the included studies.
Next, the investigators studied outcomes stratified by use of transthyretin stabilizers or silencers, referred to as disease-modifying therapy. SGLT2i use was linked with lower all-cause mortality both in patients who received disease-modifying therapies and those who did not. The prevalence of adverse events did not differ significantly between patients who received disease-modifying therapies and those who didn’t.
The study also evaluated results stratified by diabetes status, finding that the link between SGLT2i use and mortality was lower among those without diabetes.
The authors caution that many of their findings are exploratory and limited by the small number of studies included in a given analysis. They also warn that some studies carried a moderate to high risk of bias.
“These findings are clinically encouraging, particularly for patients not receiving [disease-modifying therapy] due to unmet therapeutic need,” they concluded. “Prospective randomized trials are warranted to confirm these associations and define the optimal therapeutic integration of SGLT2 inhibitors in ATTR-CM care.”
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