Physicians' Academy for Cardiovascular Education

SGLT2 inhibitor reduced HF outcomes independently of HF risk in diabetic patients

Effects of empagliflozin on risk for cardiovascular death and heart failure hospitalization across the spectrum of heart failure risk in the EMPA-REG OUTCOME trial

Literature - Fitchett D, Butler J, van de Borne P, et al, on behalf of the EMPA-REG OUTCOME trial investigators - Eur Heart J 2017; published online ahead of print

Main results


Many T2DM patients with established CVD and without HF are at high or very high risk for HF outcomes. Empagliflozin reduced adverse HF outcomes both in patients at low or high HF risk.

Editorial comment

In his editorial article, Paneni [7] comments on the paper of Fitchett et al: ‘Taken together, these findings show for the first time that an SGLT-2 inhibitor, namely empagliflozin, reduces CV mortality and HHF in patients at both high and lower risk, as well as in patients with or without either baseline or incident HF.’

The author discusses the possible mechanisms leading to the reduction of CV mortality and HF hospitalization with empagliflozin, including osmotic diuresis, reduction in sympathetic nerve activation and increase of circulating ketone bodies, and he concludes: ‘Notably, the effect of SGLT-2 inhibitors on glucose elimination is proportional to glycaemic levels, being modest or even negligible in conditions of mild hyperglycaemia. This ‘self-limiting’ action of SGLT-2 inhibitors may suggest their use also in patients without diabetes (i.e. pre-diabetes, obesity, hypertension) to prevent adverse cardiac remodelling and dysfunction. Future studies will help us to characterize further and appreciate the potential of empagliflozin and other SGLT-2 inhibitors to fight the epidemic of HF.’


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Find this article online at Eur Heart J

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