In patients with type 2 diabetes (T2D) and cancer who had been treated with potentially cardiotoxic antineoplastic therapies, the use of SGLT2 inhibitors at baseline was associated with a significantly lower risk of cancer therapy-related cardiac dysfunction (CTRCD), according to a study presented during the Global Cardio-Oncology Summit (GCOS), held in Minneapolis, MN, and simultaneously published Sept. 23 in JACC: CardioOncology.

Ammar W. Bhatti, DO; Bonnie Ky, MD, MSCE, FACC, et al., conducted a retrospective analysis to examine the impact of SGLT2 inhibitors on CTRCD in patients aged ≥18 years with T2D and cancer and no documented history of cardiomyopathy or heart failure (HF) who had been exposed to cancer treatment with potential cardiotoxic effects.

Using the TriNetX database, they identified 95,203 patients meeting the enrollment criteria, of whom 9,402 were on an SGLT2 inhibitor and 85,800 patients were not on an SGLT2 inhibitor at baseline. After propensity score matching, there were 8,675 patients in each cohort for this analysis. Their mean age was 65 years, 42% were female and 71% were White; about 19% had a gastrointestinal malignancy and about 25% had received anthracyclines.

Results showed that the primary outcome of developing CTRCD at 12 months was lower in the SGLT2 inhibitor group: 646 patients (7.45%) vs. 948 patients (10.9%) in the no SGLT2 inhibitor cohort (hazard ratio, [HR], 0.76: 95% CI, 0.69-0.84).

Looking at secondary outcomes, with SGLT2 inhibitor vs. no SGLT2 inhibitor, there was a lower risk of HF exacerbations (HR, 0.81; 95% CI, 0.72-0.90; p<0.001), all-cause mortality (HR, 0.67; 95% CI, 0.61-0.74; p<0.001) and all-cause hospitalizations/emergency department visits (HR, 0.93; 95% CI, 0.89-0.97; p<0.001). There was also a lower risk with SGLT2 inhibitors for new-onset atrial fibrillation/flutter, new-onset metastatic cancer and systemic antineoplastic therapy.

Subgroup analyses also demonstrated reduced CTRCD risk across various classes of cancer therapies in patients prescribed SGLT2 inhibitors.

The authors write that the mechanisms through which SGLT2 inhibitors may offer cardioprotection in this setting is not fully understood. Furthermore, they write that “more extensive prospective randomized trials are warranted to validate the role of SGLT2 inhibitors as a viable primary prevention strategy for patients exposed to cancer treatment with the potential for cardiotoxicity.”

In another article published in JACC: CardioOncology on Sept. 23, concurrently with its presentation at GCOS, Steven Petrow, a survivor of testicular cancer, shares his perspective on what other survivors need to know about their cardiovascular risk. Petrow writes that he did not know there would be a “health cost” to being cured of his cancer, including cardiotoxicity. He discusses who’s most at risk for heart disease after cancer, what patients can do to reduce their risk including questions to ask the clinicians, and more.

Clinical Topics: Cardio-Oncology, Cardiovascular Care Team

Keywords: Sodium-Glucose Transporter 2 Inhibitors, Diabetes Mellitus, Type 2, Cardio-oncology, Cardiotoxicity, Cancer Survivors, Heart Disease Risk Factors