medwireNews: Researchers report that being prescribed a loop diuretic is a marker of poor prognosis among people taking a sodium-glucose cotransporter (SGLT)2 inhibitor for type 2 diabetes, even if they do not have diagnosed heart failure (HF).
Their analysis of the EMPA-REG OUTCOMES trial considered 755 study participants without HF who were taking a loop diuretic, 5559 without HF who had not been prescribed a loop diuretic, and 706 with an HF diagnosis.
The findings presented by Pierpaolo Pellicori (University of Glasgow, UK) at the virtual 56th EASD Annual Meeting show that despite the absence of an HF diagnosis, people taking loop diuretics had markedly poorer outcomes than those who were not, although less poor than people with confirmed HF.
For example, among people allocated to placebo, the cardiovascular mortality rates per 1000 person–years were 35.3, 15.5, and 42.6 in the three subgroups, respectively.
The results also underline the benefits of SGLT2 inhibition, with the corresponding rates among people taking empagliflozin being markedly lower, at 19.7, 9.4, and 30.4 per 1000 person–years. Likewise, the corresponding rates of HF hospitalization per 1000 person–years were 31.7, 8.1, and 52.4 with placebo versus 22.9, 4.2, and 40.7 with empagliflozin.
There was no significant interaction between loop diuretics, HF, and outcomes for all endpoints studied – in other words whether study participants were taking these medications, and whether they had HF, did not significantly influence the effect of empagliflozin on any of the HF or mortality endpoints.
The study participants taking loop diuretics were older than those who were not and were more likely to have a diabetes duration exceeding 10 years. They had a higher BMI, a lower estimated glomerular filtration rate, and more often had a history of myocardial infarction. These people were also more likely to be taking beta blockers, ACE inhibitors, and angiotensin receptor blockers.
Given the intermediate prognosis of this group between people not taking loop diuretics and those with an HF diagnosis, the researchers believe that the group may include people with undiagnosed HF.
They note that only 31% of study participants taking a loop diuretic had an HF diagnosis, and conclude: “The diagnosis of heart failure may be missed or not reported for many patients taking a loop diuretic.”
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