Empagliflozin and HFrEF
Abstract
Where is the wisdom we have lost in knowledge?Where is the knowledge we have lost in information?"-T.S. Eliot (1) H eart failure (HF) contributes to cardiovas- cular morbidity and mortality in patients with diabetes (DM).Mortality and hospitalization rate, the most meaningful endpoints for prognosis in patients with HF, have a higher incidence in subjects with concomitant DM compared with DMfree patients with HF.HF and DM are highly interweaved pathological conditions.In fact, hyperglycemia predicts the risk of developing HF, whereas the latter frequently occurs in patients with DM, worsening their prognosis.Moreover, a large cohort of patients with HF has manifest or latent DM.Finally, the presence of glucose intolerance in subjects with HF increases the risk of disease progression and death from a cardiovascular accident.Thus, similar mechanisms may underlie the onset or progression of HF and DM.By extension, targeting a biochemical/molecular alteration in one condition should also benefit the other.However, although long-term measures apt to reduce glycemic levels show benefit in patients with DM, these agents do not improve cardiovascular outcomes in those with HF.Thus, one could argue that correcting hyperglycemia per se would unlikely arrest the myriad of other triggers/cofactors and subsequent unrolling of countless signaling pathways/cascades of events ultimately conducive of chronic cardiac decompensation.At the same time, however, this failure could be the impetus…
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence.
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