Empagliflozin and the Prevention of Heart€Failure
نویسنده
چکیده
SEE PAGE 347 H eart failure develops in more than 1 in 5 patients with diabetes mellitus (DM) older than 65 years of age and augers an extremely poor prognosis, with a median survival of approximately 4 years. The landmark EMPA-REG OUTCOME (Empagliflozin Cardiovascular Outcome Event Trial in Type 2 Diabetes Mellitus Patients) showed that empagliflozin significantly reduced the primary composite outcome of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke (hazard ratio: 0.86; 95% confidence interval: 0.74 to 0.99; p 1⁄4 0.04 for superiority) in patients with type 2 DM and established cardiovascular (CV) disease. Remarkably, empagliflozin reduced death from CV causes by 38%, hospitalization for heart failure by 35%, and progression to end-stage kidney disease in patients with type 2 DM and established CV disease (1). Notably, the improvements in primary outcomes in the EMPA-REG OUTCOMES trial occurred within the first 2 to 3 months of the trial. These striking results have raised a number of questions about the potential mechanism of action whereby empagliflozin, a renal sodium glucose transport (SGLT) inhibitor, reduces heart failure endpoints. A number of mechanisms, both cardiac and extracardiac, have
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