Cardio-renal and metabolic benefits of empagliflozin: additional indication and change in indication restrictions

Česká verzia

Authors: Ingrid Dravecká
Authors place of work: I. interná klinika LF UPJŠ a UNLP Košice
Published in the journal: Diab Obez 2023; 23(46): 113-117
Category: Reviews

Summary

People with type 2 diabetes mellitus (T2D) have a 2–4-fold increased risk of cardiovascular disease (CVD), which is potentiated by the presence of microvascular and macrovascular chronic complications of the disease. The cardiovascular and renal systems are interconnected through hormonal and humoral mechanisms. Their diseases progress gradually, with the presence of one worsening the course of the other. This cardiorenal continuum is initiated by risk factors that subsequently lead to heart failure and terminal renal failure. In addition to optimal metabolic compensation of T2D, treatment of dyslipidemia, hypertension and weight loss, it is necessary to choose for the patient a medical therapy that could influence either the risk or the course of CVD and renal disease. Beneficial effects of sodium-glucose co-transporter 2 inhibitors (SGLT2i) have been observed in all stages of the cardiorenal continuum, from patients with DM and multiple risk factors to those with CVD, heart failure or chronic kidney disease) independent of DM. Empagliflozin in the EMPA-REG OUTCOME trial in subjects with T2D and KVO reduced cardiovascular (38%) and overall (32%) mortality, reduced the risk of hospitalizations for heart failure (35%), and led to slower progression (39%). The nephroprotective effect of empagliflozin was also confirmed in the EMPA-KIDNEY study, which included subjects with/without DM, with/without CVD with different glomerular filtration rate and albuminuria. Treatment with empagliflozin resulted in a 28% reduction in progression of chronic kidney disease or CV death. In the EMPEROR-Reduced and EMPEROR-Preserved trials, empagliflozin led to a significant reduction in the risk of death, hospitalizations for heart failure, or the need for urgent evaluation for heart failure with the need for intensification of therapy, independent of ejection fraction and the presence of DM.

Keywords:

cardiorenal continuum – cardiovascular disease (CVD) – chronic kidney disease (CKD) – empagliflozin – EMPA-KIDNEY study – EMPA-REG OUTCOME study – EMPEROR-Preserved study – EMPEROR-Reduced study – type 2 diabetes mellitus (T2D)

Zdroje

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