SGLT2 inhibitors and cardiovascular outcomes in patients with diabetes following hematopoietic stem cell transplantation: A propensity-matched cohort study.

BACKGROUND

Hematopoietic stem cell transplantation (HSCT) recipients are at increased risk of cardiovascular disease, and diabetes mellitus (DM) is common after transplantation. Sodium-glucose cotransporter 2 inhibitors (SGLT2i) have demonstrated cardioprotective effects in diabetic populations, but their impact in HSCT recipients is unclear. We evaluated cardiovascular outcomes associated with SGLT2i use in diabetic HSCT patients.

METHODS

Using the TriNetX federated research network, we conducted a retrospective cohort study of patients with DM who underwent HSCT between 2014 and 2019. Patients were stratified by SGLT2i exposure. Outcomes were assessed from 100 days post-HSCT through 5 years. Primary endpoints included all-cause mortality, hospitalization, myocardial infarction, atrial fibrillation, and heart failure exacerbation. Propensity score matching (1:1) balanced baseline characteristics.

RESULTS

Among 11,682 diabetic HSCT patients, 1446 (12.4%) received SGLT2i. After matching (n = 1308 per group), SGLT2i use was associated with significantly lower all-cause mortality at 1 year (OR 0.54, 95% CI 0.41-0.71), 3 years (OR 0.56, 95% CI 0.45-0.69), and 5 years (OR 0.49, 95% CI 0.40-0.60; all p < 0.001). At 5 years, SGLT2i use was also associated with reduced hospitalization (OR 0.76, 95% CI 0.65-0.89; p < 0.001) and heart failure exacerbation (OR 0.80, 95% CI 0.68-0.95; p = 0.009). No significant differences were observed in myocardial infarction or atrial fibrillation. Findings were consistent across transplant types.

CONCLUSION

SGLT2i use was associated with reduced mortality, hospitalization, and heart failure events in diabetic HSCT recipients, with associations evident early and sustained through 5 years. Prospective studies are warranted.