Empagliflozin improves HF outcomes irrespective of baseline risk
medwireNews: Research shows that treatment with empagliflozin significantly reduces the risk for heart failure (HF) hospitalization and cardiovascular disease (CVD) death among patients with type 2 diabetes, even if their baseline risk is relatively low.
David Fitchett (St Michael’s Hospital, Toronto, Ontario, Canada) and study co-authors used the Health ABC HF Risk score to categorize the 7020 patients from the EMPA-REG OUTCOME trial according to their baseline risk for HF.
During a median 3.1 years of follow-up, the rate of HF hospitalization or CVD death among patients taking placebo who had a very high (>20%) 5-year HF risk was 70.0 per 1000 patient–years.
The researchers note that this rate was similar to that seen among patients with prevalent HF at baseline, suggesting that some actually had subclinical HF when they entered the trial.
This, together with the fact that 13.6% of the study cohort had pre-existing or developed new HF during the trial, “underscores the importance of identifying susceptible individuals to optimize preventive strategies,” they write in the European Heart Journal.
Among patients with very high HF risk, empagliflozin treatment reduced the risk for HF hospitalization or CVD death by a significant 45%, giving a rate of 38.0 per 1000 patient–years. The pattern was similar for patients with high HF risk (10–20%), at 20.7 per 1000 patient–years for empagliflozin-treated patients versus 40.3 per 1000 patient–years for those in the placebo group, giving a 48% reduction, and for those with low to average risk (<10%), at 12.0 versus 16.8 per 1000 patient–years and a 29% reduction.
The positive effects of empagliflozin on HF risk were evident from 1 month after starting treatment, and persisted throughout follow-up.
In an accompanying editorial, Francesco Paneni (University Hospital Zürich, Switzerland) describes the findings as “timely and of high clinical impact,” suggesting that they strengthen the argument for adding sodium-glucose co-transporter (SGLT)2 inhibitors to established medications such as metformin to reduce HF risk in diabetes patients.
“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,” he says.
“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.”
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