Non-antiarrhythmic pharmacotherapy in cardio-renal-metabolic disease and incident atrial fibrillation: a trial meta-analysis.

Pharmacotherapy of cardio-renal-metabolic diseases may prevent incident AF.

心血管-肾脏-代谢疾病的药物治疗可能预防新发AF。

This meta-analysisestimates the effect of different pharmacotherapies on risk of incident AF across cardio-renal-metabolic diseases.

本荟萃分析估计了不同药物治疗对心血管-肾脏-代谢疾病患者新发房颤风险的影响。

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.

检索了Medline、Embase和Cochrane Central数据库，直至2025年10月7日，以寻找比较非抗心律失常的心血管-肾脏-代谢药物与对照或其他药物对新发房颤影响的随机临床试验（RCTs）。

Random-effects meta-analysisusing 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).

采用Mantel-Haenszel方法进行随机效应元分析，并使用DerSimonian-Laird方法估计研究间方差，以合成风险比（RR）及其95%置信区间（CI）。

Results

Two hundred and forty-nine RCTs involving 745 041 patients were included, of which 207 identified AF through adverse eventreports, 161 were placebo-controlled, and 15 had AF as a pre-specified endpoint.

共纳入249项随机对照试验（RCTs），涉及745,041名患者，其中207项通过不良事件报告识别出房颤（AF），161项为安慰剂对照试验，15项将房颤作为预先设定的终点。

In placebo-controlledtrials, 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).

在安慰剂对照试验中，使用血管紧张素转换酶抑制剂和血管紧张素受体阻滞剂治疗射血分数降低的心力衰竭时，观察到新发房颤的显著差异（相对风险 RR 0.69，95% 置信区间 CI 0.60-0.80），使用盐皮质激素受体拮抗剂（RR 0.62，95% CI 0.43-0.90），以及钠-葡萄糖共转运蛋白 2（SGLT2）抑制剂（RR 0.62，95% CI 0.44-0.87）；使用SGLT2抑制剂治疗慢性肾脏病（RR 0.53，95% CI 0.33-0.85）；以及使用胰高血糖素样肽-1受体激动剂治疗肥胖（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.

然而，每项试验中房颤事件的数量较低，且没有一项试验对新发房颤有足够的统计功效。

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.

未来的针对心脏-肾脏-代谢药物的试验设计中应整合前瞻性随机对照试验（RCTs），以确定这些药物是否能减少新发房颤（AF）的发生。

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.

未来的针对心脏-肾脏-代谢药物的试验设计中应整合前瞻性随机对照试验（RCTs），以确定这些药物是否能减少新发房颤（AF）的发生。