Physicians' Academy for Cardiovascular Education

CV Protection in the EMPA-REG OUTCOME Trial: A ‘Thrifty Substrate’ Hypothesis

Lecture - July 31, 2016 - Asian Interchange on Diabetes meeting - Michael Mark, MD, Boehringer Ingelheim – Cardiometabolic Diseases Research

Michael Mark proposes a new hypothesis that may explain the observed CV benefit of empagliflozin, involving increased haematocrit and higher ketone bodies as a potent alternative energy source.

This lecture was recorded at the Asian Interchange on Diabetes meeting, held in Bangkok on July 30-31, 2016.

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  • A recap of the study design of the EMPA-REG OUTCOME study 0:41
  • A closer look at the mortality benefit seen with empagliflozin treatment as compared with placebo 2:07
  • Speculating on the underlying mechanism of the CV benefit seen with empagliflozin treatment 4:15
  • A new hypothesis emerges: empagliflozin increases oxygen delivery to organs by increasing hematocrit 11:03
  • Part two of the new hypothesis, involving increased ketone bodies featuring as a 'superfuel' 16:08
  • A covariate analysis of the EMPA-REG OUTCOME data provides evidence for the new hypothesis 23:13