Researchers of a large, randomized trial evaluated the cardiovascular effects of empagliflozin, a sodium-glucose cotransporter 2 (SGLT2) inhibitor, in patients with type 2 diabetes at high cardiovascular risk. Over a median of 3.1 years, patients received either empagliflozin (10 mg or 25 mg daily) or placebo, in addition to standard care. The primary outcome was a composite of cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke. Among over 7,000 patients, the empagliflozin group showed a modest but statistically significant reduction in the primary composite outcome compared to placebo (hazard ratio, 0.86; P=0.04).

While rates of myocardial infarction and stroke were similar between groups, empagliflozin was associated with substantial reductions in death from cardiovascular causes (38% relative risk reduction), hospitalization for heart failure (35% reduction), and death from any cause (32% reduction). The key secondary outcome, which added unstable angina to the primary composite, did not show a statistically significant difference. Although genital infections were more frequent in the empagliflozin group, there was no increase in serious adverse events. Overall, empagliflozin significantly reduced mortality and heart failure hospitalizations in high-risk patients with type 2 diabetes.

Reference: Zinman B, Wanner C, Lachin JM, et al. Empagliflozin, Cardiovascular Outcomes, and Mortality in Type 2 Diabetes. N Engl J Med. 2015;373(22):2117-28. doi: 10.1056/NEJMoa1504720