{"id":6017,"date":"2018-11-21T09:07:45","date_gmt":"2018-11-21T14:07:45","guid":{"rendered":"https:\/\/cardiologynownews.org\/?p=6017"},"modified":"2018-11-21T09:07:45","modified_gmt":"2018-11-21T14:07:45","slug":"mechanistic-study-delves-into-heart-failure-benefits-noted-with-empagliflozin","status":"publish","type":"post","link":"https:\/\/cardiologynownews.org\/?p=6017","title":{"rendered":"Mechanistic Study Delves Into Heart Failure Benefits Noted With Empagliflozin"},"content":{"rendered":"<p>The EMPA-HEART trial showed that empagliflozin resulted in beneficial effects on left ventricular remodeling at 6 months among patients with type 2 diabetes mellitus and stable coronary artery disease (CAD) but normal ejection fraction and without a clear heart failure history. The findings were presented by Dr. Subodh Verma at the American Heart Association Annual Scientific Sessions (AHA 2018) in Chicago, Illinois.<!--more--><\/p>\n<p>The investigators aimed to assess the efficacy of empagliflozin on left ventricular (LV) remodeling among patients with type 2 diabetes mellitus (DM2) with or without prior heart failure (HF). A total of 423 eligible patients were randomized in a 1:1 ratio to either empagliflozin 10 mg daily (n = 49) or placebo (n = 48).\u00a0The study included patients who were \u226540 and \u226480 years of age with a history of type 2 diabetes mellitus, hemoglobin A1c \u22656.5% and \u226410 % within 3 months of the screening visit, established coronary artery disease (CAD) (prior coronary revascularization or history of myocardial infarction) and with a stable (\u22652 months) background of antihyperglycemic therapy. Side by side, patients using a sodium-glucose cotransporter-2 (SGLT2) inhibitor, glucagon-like peptide-1 receptor agonist (GLP-1 RA), or saxagliptin were excluded.\u00a0The investigators found that the primary outcome of change in LV mass index on cardiac magnetic resonance (CMR) from baseline to 6 months, for empagliflozin vs. placebo, was \u00a0-2.6 vs. -0.01 g\/m<sup>2<\/sup>, p = 0.01. Moreover, the greatest improvement among patients with LV mass index was &gt;60 g\/m<sup>2<\/sup>\u00a0(p for interaction = 0.007). A look at the secondary outcomes, for empagliflozin vs. placebo showed that change in systolic BP was -7.9 vs. -0.7 mm Hg (p = 0.003), change in diastolic BP was 2.0 vs. 0.8 mm Hg (p = 0.22), change in haematocrit was 2.4 vs. 0.4% (p = 0.006), change in LV end-systolic volume index was 1.0 vs. 0.04 ml\/m<sup>2<\/sup> (p = 0.36), change in LVEF was 2.2% vs. -0.01% (p = 0.07).<\/p>\n<p><img loading=\"lazy\" loading=\"lazy\" decoding=\"async\" class=\" wp-image-6019 alignleft\" src=\"https:\/\/cardiologynownews.org\/wp-content\/uploads\/2018\/11\/Ant.jpg\" alt=\"\" width=\"126\" height=\"189\" \/>[perfectpullquote align=&#8221;full&#8221; bordertop=&#8221;false&#8221; cite=&#8221;&#8221; link=&#8221;&#8221; color=&#8221;&#8221; class=&#8221;&#8221; size=&#8221;&#8221;]<strong>&#8220;I plan to increase my use of SGLT2 inhibitors in my patients with type\u00a02 diabetes, especially if they have a history of heart failure and especially if they have a history of coronary heart disease. I would encourage you to do the same and I would also recommend that we urge our colleagues in general medicine, in endocrinology, and in nephrology to consider this information as well.&#8221;- Dr. Eliott Antman, M.D.<\/strong>[\/perfectpullquote]<\/p>\n<p>The results of this trial indicated that empagliflozin resulted in favorable effects on LV remodeling at 6 months among patients with DM2 and stable CAD but normal EF and without a clear history of HF (only 6% had known HF in this trial). The investigators found that the effect was most prominent among those with Left Ventricular mass index &gt;60 g\/m<sup>2<\/sup>\u00a0at baseline. Beneficial effects were also noted for systolic BP and hematocrit, but not in NT-proBNP or troponin levels. Thus, this was an interesting mechanistic study that sought to delve into the cardiovascular benefits, particularly the heart failure benefits, noted with empagliflozin in the EMPA-REG OUTCOME trial.\u00a0&#8220;I plan to increase my use of SGLT2 inhibitors in my patients with type\u00a02 diabetes, especially if they have a history of heart failure and especially if they have a history of coronary heart disease,&#8221;\u00a0 commented discussant Dr. Elliott Antman, Brigham and Women&#8217;s Hospital, Boston,\u00a0 during the session at AHA.\u00a0&#8220;I would encourage you to do the same and I would also recommend that we urge our colleagues in general medicine, in endocrinology, and in nephrology to consider this information as well,&#8221; Dr. Antman remarked.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>The EMPA-HEART trial showed that empagliflozin resulted in beneficial effects on left ventricular remodeling at 6 months among patients with type 2 diabetes mellitus and stable coronary artery disease (CAD) but normal ejection fraction and without a clear heart failure history. The findings were presented by Dr. Subodh Verma at the American Heart Association Annual [&hellip;]<\/p>\n","protected":false},"author":8,"featured_media":6016,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[184,29,14,8],"tags":[47],"ppma_author":[1033],"class_list":{"0":"post-6017","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-clinical-trials","8":"category-conferences","9":"category-heart-failure","10":"category-news","11":"tag-featured","12":"author-sudarshana-datta"},"authors":[{"term_id":1033,"user_id":8,"is_guest":0,"slug":"sudarshana-datta","display_name":"Sudarshana Datta, M.D.","avatar_url":"https:\/\/secure.gravatar.com\/avatar\/b79d07e34756cd9e4c6fe8c77835538219f3ec30c82a6bf8f218760a5f29c84a?s=96&r=g","0":null,"1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":""}],"_links":{"self":[{"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/posts\/6017","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/users\/8"}],"replies":[{"embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=6017"}],"version-history":[{"count":4,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/posts\/6017\/revisions"}],"predecessor-version":[{"id":6030,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/posts\/6017\/revisions\/6030"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/media\/6016"}],"wp:attachment":[{"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=6017"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=6017"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=6017"},{"taxonomy":"author","embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fppma_author&post=6017"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}