Effect of empagliflozin beyond glycemic control: Cardiovascular benefit in patients with type 2 diabetes and established cardiovascular disease
Rev Port Cardiol (Engl Ed). 2019 Oct;38(10):721-735.
doi: 10.1016/j.repc.2019.02.008.
Epub 2019 Dec 28.
[Article in
English,
Portuguese]
Affiliations
- 1 Serviço de Cardiologia A, Centro Hospitalar e Universitário de Coimbra, Faculdade de Medicina da Universidade de Coimbra, Coimbra, Portugal. Electronic address: pedromontei@gmail.com.
- 2 Serviço de Cardiologia, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal.
- 3 Departamento de Cardiologia, Associação Protectora dos Diabéticos de Portugal; Centro do Coração, Hospital CUF Infante Santo, Lisboa, Portugal.
- 4 Serviço de Endocrinologia, Diabetes e Metabolismo do Hospital de Curry Cabral, Centro Hospitalar de Lisboa Central; Escola Superior de Tecnologia da Saúde do Instituto Politécnico de Lisboa; NOVA Medical School/Faculdade de Ciências Médicas da Universidade Nova de Lisboa, Lisboa, Portugal.
- 5 Departamento de Nefrologia, Associação Protetora dos Diabéticos de Portugal; Serviço de Nefrologia, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal.
- 6 Serviço de Nefrologia, Hospital de Curry Cabral, Centro Hospitalar de Lisboa Central; Centre for Toxicogenomics and Human Health (ToxOmics), Genetics, Oncology and Human Toxicology, Nova Medical School/Faculdade de Ciências Médicas da Universidade Nova de Lisboa, Lisboa, Portugal.
- 7 Serviço de Endocrinologia, Diabetes e Metabolismo, Centro Hospitalar e Universitário de Coimbra, Faculdade de Medicina da Universidade de Coimbra, Coimbra, Portugal.
- 8 Departmento de Medicina, Centro de Investigação em Tecnologias e Serviços de Saúde, Faculdade de Medicina da Universidade do Porto; Unidade de Hipertensão, Unidade Local de Saúde de Matosinhos, Porto/Matosinhos, Portugal.
Abstract
The prevalence of type 2 diabetes (T2D) continues to increase, and its association with cardiovascular (CV) disease has led to the inclusion of CV endpoints in clinical trials on the treatment of T2D. This article explores the various trials already performed and under development in this field, with particular focus on the EMPA-REG OUTCOME trial. In this trial, empagliflozin, a sodium-glucose co-transporter 2 inhibitor, demonstrated a reduction in CV risk in patients with T2D and established CV disease, in addition to CV safety and a decrease in glycated hemoglobin. This represents a paradigm shift that has led to changes in the international guidelines for the treatment of T2D. These results were maintained in subsequent subgroup analysis for heart failure, chronic kidney disease and peripheral arterial disease, although there are many questions concerning the mechanisms involved in these effects, including whether they are hemodynamic, metabolic or due to decreased myocardial cytoplasmic sodium concentrations. With this reduction in risk for major CV events in patients with T2D, the EMPA-REG OUTCOME trial demonstrated CV protection from a hypoglycemic drug for the first time, and opened a new era in the treatment and management of T2D. This study has led to the development of ongoing trials that will establish which patients will benefit most from this therapy, particularly with regard to comorbidities.
Keywords:
Cardiovascular disease; Diabetes; Doença cardiovascular; Empagliflozin; Empagliflozina; Heart failure; Insuficiência cardíaca.
Copyright © 2019 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.
MeSH terms
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Benzhydryl Compounds / therapeutic use*
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Blood Glucose / analysis*
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Cardiovascular Diseases* / complications
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Cardiovascular Diseases* / physiopathology
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Diabetes Mellitus, Type 2* / complications
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Diabetes Mellitus, Type 2* / drug therapy
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Diabetes Mellitus, Type 2* / metabolism
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Glucosides / therapeutic use*
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Humans
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Sodium-Glucose Transporter 2 Inhibitors / therapeutic use*
Substances
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Benzhydryl Compounds
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Blood Glucose
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Glucosides
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Sodium-Glucose Transporter 2 Inhibitors
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empagliflozin