Improvement in Cardiovascular Outcomes With Empagliflozin Is Independent of Glycemic Control
Abstract
Key Words: blood glucose ◼ sodiumglucose transporter 2 ◼ treatment outcome ◼ type 2 diabetes mellitus C ardiovascular disease (CVD) is the leading cause of death in type 2 diabetes mellitus (T2DM). 1 However, control of the major metabolic derangement of T2DM, hyperglycemia, as denoted by hemoglobin A1c (HbA1c), does not substantively impact its cardiovascular complications. 2 In the EMPA-REG OUT-COME trial (Empagliflozin Cardiovascular Outcome Event Trial in Type 2 Diabetes Mellitus Patients) involving 7020 patients with T2DM and established CVD, the SGLT2 inhibitor empagliflozin reduced the risk of 3-point major adverse cardiovascular events (composite of nonfatal myocardial infarction, nonfatal stroke, and cardiovascular death) by 14%. 3 This effect was driven by a 38% reduction in cardiovascular death. 3Empagliflozin also reduced heart failure (HF) hospitalization by 35%. 3 Until EMPA-REG OUTCOME, such cardiovascular benefits had not been demonstrated by any glucose-lowering agent, and the data led to a label indication for empagliflozin to reduce cardiovascular mortality.We have previously reported no heterogeneity in the cardiovascular effects of empagliflozin in subgroups by HbA1c < versus ≥8.5% at baseline. 3,4Building on this, we analyzed the risks of cardiovascular death, HF hospitalization, and the composite of HF hospitalization or cardiovascular death (1) in subgroups stratified by baseline HbA1c (<7%; 7% to <8%; 8% to <9%; ≥9%) and (2) after adjustment for…
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