Effect of Sodium-Glucose Cotransporter-2 Inhibitors on Cardiovascular Outcomes in COVID-19 Patients

ABSTRACT

Background: Recent data has shown that sodium-glucose cotransporter-2 (SGLT- 2) inhibitors decrease cardiac related mortality in patients with and without diabetes. In this study we aim to explore the relationship between outcomes in patients hospitalized with coronavirus disease 19 (COVID-19) and whether they did or did not take SGLT-2 inhibitors. Method(s) Using an observational database, we analyzed 3293 unvaccinated hospitalized COVID-19 PCR-positive patients at Methodist Health System from March to December 2020. We compared incidence of in-hospital death or hospice referral rates, major acute cardiovascular event (MACE), and acute respiratory failure requiring mechanical ventilation between patients who did or did not take SGLT-2 inhibitors on first encounter. In this study, MACE was identified as congestive heart failure (CHF) exacerbation, pericarditis, pericardial effusion, myocardial infarction (MI), stroke, pulmonary embolism (PE), deep venous thrombosis (DVT), or shock. We used Chisquare and odds ratio tests to analyze observed variables. Result(s) Of the 3293 COVID-19 patients, 149 (4.5%) took SGLT-2 inhibitors prior to admission while 3144 (95.5%) did not. A statistically significant difference was observed when comparing mortality as an outcome between patients who took SGLT-2 prior to admission and those who did not (OR 0.54, 95% CI 0.29-0.98, p = 0.04). Interestingly, an opposite trend was seen in these two groups when comparing whether they had an incidence of MACE during hospitalization (OR 2.36, 95% 1.69 - 3.29, p < 0.01). In specific, patients who took SGLT-2 prior to admission had higher incidences of MI (OR 2.02, 95% CI 1.43 - 2.85, p < 0.01) and stroke (OR 1.28, 95% CI 2.87 - 7.82, p < 0.01). Finally, we noted that there was no statistically significant difference in incidence of acute respiratory failure leading to intubation (p = 0.35), or mortality of intubated patients (p=0.18) when comparing these two groups. Conclusion(s) SGLT-2 inhibitors use was associated with a decreased incidence of in-hospital mortality of patients admitted with COVID-19 infection even in a patient population that had a significantly higher number of MACE during hospitalization. We also show that SGLT-2 inhibitors had no association with change in incidence of acute respiratory failure requiring intubation in this patient population.