USA: The use of SGLT2 inhibitor empagliflozin in heart failure patients lowers the risk of cardiovascular death and hospitalization for heart failure regardless of the absence or presence of diabetes, suggests a recent study in NEJM.
Sodium-glucose cotransporter 2 (SGLT2) inhibitors are known to reduce the risk of hospitalization in heart failure patients regardless of the absence or presence of diabetes. More evidence is required on the effects of these drugs across the broad spectrum of heart failure, including those having a markedly reduced ejection fraction. To determine the same, Milton Packer, Baylor University Medical Center, Dallas, and colleagues conducted a double-blind trial that included 3730 patients with class II, III, or IV heart failure and an ejection fraction of 40% or less. They were randomly assigned to receive 40% or less to receive empagliflozin (10 mg once daily) or placebo, in addition to recommended therapy.
The primary outcome was a composite of cardiovascular death or hospitalization for worsening heart failure.
Key findings of the study include:
During a median of 16 months, a primary outcome event occurred in 361 of 1863 patients (19.4%) in the empagliflozin group and in 462 of 1867 patients (24.7%) in the placebo group (hazard ratio for cardiovascular death or hospitalization for heart failure, 0.75).
The effect of empagliflozin on the primary outcome was consistent in patients regardless of the presence or absence of diabetes.
The total number of hospitalizations for heart failure was lower in the empagliflozin group than in the placebo group (hazard ratio, 0.70).
The annual rate of decline in the estimated glomerular filtration rate was slower in the empagliflozin group than in the placebo group (–0.55 vs. –2.28 ml per minute per 1.73 m2 of body-surface area per year), and empagliflozin-treated patients had a lower risk of serious renal outcomes.
Uncomplicated genital tract infection was reported more frequently with empagliflozin.
"Empagliflozin was associated with a reduced incidence in cardiovascular death or hospitalization for heart failure compared with placebo among patients with class II–IV heart failure with reduced ejection fraction, wrote the authors.
"Empagliflozin may provide a cardioprotective effect regardless of the presence, or not, of diabetes," they concluded.
The study, "Cardiovascular and Renal Outcomes with Empagliflozin in Heart Failure," is published in the New England Journal of Medicine.
https://www.nejm.org/doi/pdf/10.1056/NEJMoa2022190