Results of EMPEROR-Reduced study: effect of empagliflozin on heart failure in patients with reduced ejection fraction
Excelentný tím pre výskum aterosklerózy (EXTASY), IV. interná klinika LF UPJŠ a UN LP Košice
Forum Diab 2020; 142(3): 203-206
The studies of cardiovascular safety with SGLT2 inhibitors have repeatedly shown that these drugs reduce the number of hospitalizations for heart failure (HF) which was defined as a secondary outcome in the above-mentioned studies. The EMPEROR-Reduced study sought to answer the question whether SGLT2 inhibitor empagliflozin reduces the primary outcome (cardiovascular mortality or hospitalization for HF) in both diabetic and non-diabetic patients with HF and reduced ejection fraction (HFrEF). Add-on treatment with empagliflozin to previous standard HF treatment resulted in a significant 25 % reduction in the primary outcome. The incidence of hospitalizations for HF was significantly reduced by 30 %. The results of the EMPEROR-Reduced study replicated the previously published results of a similarly designed study with dapagliflozin (DAPA-HF). A meta-analysis of these studies showed that SGLT2 inhibitors also significantly reduced cardiovascular and total mortality in patients with HFrEF. Therefore, SGLT2 inhibitors should be a standard part of HFrEF treatment together with beta-blockers, mineralocorticoid receptor antagonists and angiotensin receptor-neprilysin inhibitors.
heart failure – type 2 diabetes mellitus – SGLT2 inhibitors – empagliflozin
- Zinman B, Wanner C, Lachin JM et al. Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes. N Engl J Med 2015; 373(22): 2117–2128. Dostupné z DOI: <http://dx.doi.org/10.1056/NEJMoa1504720>.
- Neal B, Perkovic V, Mahaffey KW et al. Canagliflozin and cardiovascular and renal events in type 2 diabetes. N Engl J Med 2017; 377(7): 644–657. Dostupné z DOI: <http://dx.doi.org/10.1056/NEJMoa1611925>.
- Wiviott SD, Raz I, Bonaca MP et al. Dapagliflozin and cardiovascular outcomes in type 2 diabetes. N Engl J Med 2019; 380(4): 347–357. Dostupné z DOI: <http://dx.doi.org/10.1056/NEJMoa1812389>.
- Cannon CP, Pratley R, Dagogo-Jack S et al. Cardiovascular Outcomes with Ertugliflozin in Type 2 Diabetes. N Engl J Med 2020; 383(15): 1425–1435. Dostupné z DOI: <http://dx.doi.org/10.1056/NEJMoa2004967>.
- McMurray JJ, Solomon SD, Inzucchi SE et al. Dapagliflozin in patients with heart failure and reduced ejection fraction. N Engl J Med 2019; 381(21): 1995–2008. Dostupné z DOI: <http://dx.doi.org/10.1056/NEJMoa1911303>.
- Packer M, Anker SD, Butler J et al. Cardiovascular and renal outcomes with empagliflozin in heart failure. N Engl J Med 2020; 383: 1413–1424. Dostupné z DOI: <http://dx.doi.org/10.1056/NEJMoa2022190>.
- Zannad F, Ferreira JP, Pocock SJ et al. SGLT2 inhibitors in patients with heart failure with reduced ejection fraction: a meta-analysis of the EMPEROR-Reduced and DAPA-HF trials. Lancet 2020; 396(10254): 819–829. Dostupné z DOI: <http://dx.doi.org/10.1016/S0140–6736(20)31824–9>.
- Zannad F, McMurrey JJV, Krum H et al. Eplerenone in patients with systolic heart failure and mild symptoms. N Engl J Med 2011; 364(1): 11–21. Dostupné z DOI: <http://dx.doi.org/10.1056/NEJMoa1009492>.
- McMurray JJV, Packer M, Desai AS et al. Angiotensin-neprilysin inhibition versus enalapril in heart failure. N Engl J Med 2014; 371(11): 993–1004. Dostupné z DOI: <http://dx.doi.org/10.1056/NEJMoa1409077>.
- Vaduganthan M, Claggett BL, Jhund PS et al. Estimating lifetime benefits of comprehensive disease-modifying pharmacological therapies in patients with heart failure with reduced ejection fraction: a comparative analysis of three randomised controlled trials. Lancet 2020; 396(10244): 121–128. Dostupné z DOI: <http://dx.doi.org/10.1016/S0140–6736(20)30748–0>.