SGLT2i reduces the recurrence rate of vasovagal syncope in patients with type 2 diabetes

Vaso-vagal syncope (VVS) is a transient loss of consciousness caused by transient systemic hypoperfusion
.

The onset of symptoms is rapid and often self-resolving, and nearly 35% of VVS cases recur
.

 Notably, type 2 diabetes mellitus (T2DM) was an independent predictor of VVS recurrence
.

Previous studies have shown that the direct effect of sodium-glucose cotransporter 2 inhibitors (SGLT2i) on glycemic control can lead to cardiovascular benefits in patients with T2DM
.

In addition, SGLT2i exerts a cardiovascular protective effect (independent of glycemic control) by modulating sympathetic nerve activity
.


Recently, a multicenter prospective study conducted by Dr.
Celestino Sardu and colleagues from the University of Campania in Italy in six Italian hospitals investigated whether SGLT2i can improve autonomic dysfunction (cardiac dysfunction) in T2DM patients with VVS.
autonomic dysfunction, CAN), thereby reducing VVS recurrence
.

 This research report is the first in the world to propose that SGLT2i can reduce the recurrence rate of VVS, which is an innovative exploration of the application of SGLT2i drugs
.

STUDY METHODS: The 607 patients with T2DM enrolled in the study were drawn from 4794 consecutive patients who had at least 2 VVS events in the 6 months prior to receiving the trial and relapsed VVS in the upright tilt test (HUT)
.

 The final inclusion of T2DM patients met the following criteria: ≥18 years old, with HUT indications, with 123I-miodobenzylguanidine myocardial imaging (123I-MIBG) indications, no previous cardiovascular disease, eGFR≥30ml/min/1.
73m2
.

Of these, 161 patients had been taking SGLT2i uninterrupted for at least 6 months prior to the study, and the investigators defined them as SGLT2i users (receiving 10 mg/d or 25 mg/d empagliflozin, or canagliflozin 100 mg/d) ), and the remaining patients were defined as non-SGLT2i users
.

 Figure 1 Inclusion criteria The enrolled patients were evaluated by clinicians for 1 year on the 10th, 3rd, 6th, and 12th months of discharge.
The clinical evaluation included physical examination, vital signs and adverse event review.

.

At enrollment and one year later, patients underwent a series of blood, cardiac, and neurological tests/examinations to assess cardiac sympathetic activity and VVS recurrence by comparing heart rate variability and 123I-MIBG differences between the two groups
.

RESULTS: During 1-year follow-up, SGLT2i users had a significantly lower incidence of VVS (45%) than non-users
.

In addition, non-SGLT2i users had higher levels of inflammatory markers and catecholamines, worse glycemic control, and more severe autonomic nervous system dysfunction compared with SGLT2i users
.

 Patients in the three subgroups (empagliflozin 10 mg/d, empagliflozin 25 mg/d, and canagliflozin 100 mg/d) had similar cardiovascular outcomes compared with patients who did not undergo SGLT2i
.

 Studies have shown that SGLT2i treatment has a positive effect on the prevention of VVS recurrence in T2DM patients
.

  References: [1] Marlene Busko.
SGLT2 Inhibitors May Cut Repeat Syncope in Type 2 Diabetes, Medscape, February 16, 2022 [2] Celestino Sardu, Massimo Massetti, Pietro Rambaldi et al.
SGLT2-inhibitors modulate the Cardiac Autonomic Neuropathy and reduce the vaso-vagal syncope recurrence in patients with type 2 diabetes mellitus: the SCAN study, 04 February 2022, PREPRINT (Version 1) available at Research Square [https://doi.
org/10.
21203/rs.
3.
rs-1317377/ v1]