| Title: |
Non-antiarrhythmic pharmacotherapy in cardio-renal-metabolic disease and incident atrial fibrillation: a trial meta-analysis |
| Authors: |
Raveendra, K; Nadarajah, R; Larvin, H; Farooq, M; Haris, M; Cutting, U; Kang, J; Wilkinson, C; Dalakoti, M; Kotecha, D; Lip, GYH; Boriani, G; Camm, AJ; Van Gelder, IC; Wu, J; Gale, CP |
| Publisher Information: |
Oxford University Press (OUP) |
| Publication Year: |
2026 |
| Collection: |
St George's University of London: Repository |
| Description: |
Background and Aims Atrial fibrillation (AF) disease burden is increasing. Pharmacotherapy of cardio-renal-metabolic diseases may prevent incident AF. This meta-analysis estimates the effect of different pharmacotherapies on risk of incident AF across cardio-renal-metabolic diseases. Methods The Medline, Embase, and Cochrane Central databases were searched to 7 October 2025 for randomized clinical trials (RCTs) comparing the effect of a non-antiarrhythmic cardio-renal-metabolic medication with control or another agent for incident AF. Random-effects meta-analysis using the Mantel–Haenszel method, with between-study variance estimated using the DerSimonian–Laird method, was performed to synthesize risk ratios (RR) with 95% confidence intervals (CI). Results Two hundred and forty-nine RCTs involving 745 041 patients were included, of which 207 identified AF through adverse event reports, 161 were placebo-controlled, and 15 had AF as a pre-specified endpoint. In placebo-controlled trials, significant differences in incident AF were observed with treatment of heart failure with reduced ejection fraction with angiotensin-converting enzyme inhibitors and angiotensin receptor blockers (RR 0.69, 95% CI 0.60–0.80), mineralocorticoid receptor antagonists (RR 0.62, 95% CI 0.43–0.90), and sodium-glucose co-transporter 2 (SGLT2) inhibitors (RR 0.62, 95% CI 0.44–0.87); treatment of chronic kidney disease with SGLT2 inhibitors (RR 0.53, 95% CI 0.33–0.85); and treatment of obesity with glucagon-like peptide-1 receptor agonists (RR 0.79, 95% CI 0.63–0.99). However, the number of AF events per trial was low and none were adequately powered for incident AF. Conclusions Prospective RCTs with AF as a pre-specified outcome should be integrated into the design of future trials of cardio-renal-metabolic medications to determine whether they reduce incident AF. |
| Document Type: |
article in journal/newspaper |
| File Description: |
application/pdf; application/zip |
| Language: |
English |
| ISSN: |
0195-668X |
| Relation: |
https://openaccess.sgul.ac.uk/id/eprint/118271/1/ehag021.pdf; https://openaccess.sgul.ac.uk/id/eprint/118271/2/ehag021_supplementary_data.zip; Raveendra, K; Nadarajah, R; Larvin, H; Farooq, M; Haris, M; Cutting, U; Kang, J; Wilkinson, C; Dalakoti, M; Kotecha, D; et al. Raveendra, K; Nadarajah, R; Larvin, H; Farooq, M; Haris, M; Cutting, U; Kang, J; Wilkinson, C; Dalakoti, M; Kotecha, D; Lip, GYH; Boriani, G; Camm, AJ; Van Gelder, IC; Wu, J; Gale, CP (2026) Non-antiarrhythmic pharmacotherapy in cardio-renal-metabolic disease and incident atrial fibrillation: a trial meta-analysis. European Heart Journal. ISSN 0195-668X https://doi.org/10.1093/eurheartj/ehag021 SGUL Authors: Camm, Alan John |
| DOI: |
10.1093/eurheartj/ehag021 |
| Availability: |
https://openaccess.sgul.ac.uk/id/eprint/118271/; https://openaccess.sgul.ac.uk/id/eprint/118271/1/ehag021.pdf; https://openaccess.sgul.ac.uk/id/eprint/118271/2/ehag021_supplementary_data.zip; https://doi.org/10.1093/eurheartj/ehag021 |
| Rights: |
cc_by_4 |
| Accession Number: |
edsbas.235273B3 |
| Database: |
BASE |