SGLT2 Inhibitors and Cardiovascular Outcomes in Patients With Diabetes Following Hematopoietic Stem Cell Transplantation: A Propenisity-Matched Cohort Study

Document Type

Conference Proceeding

Publication Date

4-7-2026

Publication Title

Journal of the American College of Cardiology

Abstract

BACKGROUND Hematopoietic stem cell transplantation (HSCT) recipients face cardiovascular disease rates 4-fold higher than the general population, with diabetes mellitus (DM) affecting up to 30% of patients post-transplant. Sodium-glucose cotransporter 2 inhibitors (SGLT2i) demonstrate cardioprotective effects in diabetic populations, but their impact in post-HSCT patients remains unknown. We evaluated cardiovascular outcomes associated with SGLT2i use in diabetic HSCT recipients. METHODS We used TriNetX to conduct a retrospective cohort study of patients with DM who underwent HSCT from 2014-2019. Patients were categorized by SGLT2i exposure and outcomes were assessed from 100 days post-HSCT through 5-year follow-up. Primary endpoints included all-cause mortality, hospitalization, acute myocardial infarction, atrial fibrillation, cerebrovascular events, and heart failure exacerbation. Propensity score matching (1:1) balanced cohorts for demographics, comorbidities, transplant characteristics, and conditioning regimens. RESULTS Among 12,539 diabetic HSCT patients, 1,433 (11.4%) received SGLT2i. After propensity matching (n=1,412 per group), SGLT2i users demonstrated significantly reduced all-cause mortality at all timepoints: 1-year (OR 0.52, 95% CI 0.41-0.66), 3-year (OR 0.45, 95% CI 0.37-0.56), and 5-year (OR 0.41, 95% CI 0.34-0.50; all p< 0.01), representing up to 59% relative risk reduction. At 5 years, SGLT2i use was associated with reduced all-cause hospitalization (OR 0.73, 95% CI 0.63-0.85) and heart failure exacerbation (OR 0.58, 95% CI 0.47- 0.72; both p< 0.01). No differences were observed in myocardial infarction, atrial fibrillation, or cerebrovascular events. Benefits were consistent across allogeneic and autologous transplant recipients. CONCLUSION In this large propensity-matched cohort, SGLT2i use was associated with substantial reductions in mortality and heart failure events among diabetic HSCT recipients, with benefits emerging by 1 year and persisting through 5 years. These findings suggest SGLT2i may represent an important cardioprotective strategy in this high-risk population, though prospective validation is needed.

Volume

87

Issue

13 Suppl

First Page

A1112

Comments

American College of Cardiology 75th Annual Scientific Session & Expo, March 28-30, 2026, New Orleans, LA

Last Page

A1112

DOI

10.1016/j.jacc.2026.02.2727

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