Empagliflozin for Heart Failure With Preserved Left Ventricular Ejection Fraction With and Without Diabetes
Circulation 2022; online ahead of print
In patients enrolled in EMPEROR-Preserved, empagliflozin significantly reduced the risk of heart failure (HF) outcomes irrespective of diabetes status.
Diabetes is present in nearly half of people with heart failure with preserved ejection fraction (HFpEF), and is associated with increased morbidity and mortality. Sodium-glucose cotransporter-2 inhibitors (SGLT2i) have been shown to improve CV composite outcomes in patients with diabetes, as well as the risk of CV death, hospitalisation for HF, and renal events. Studies of SGLT2i in those with reduced ejection fraction have also shown improved outcomes independent of diabetes status.
In this prespecified analysis of the EMPEROR-Preserved trial, empagliflozin significantly reduced the risk of HF outcomes and slowed kidney function decline in patients with HFpEF regardless of the presence of diabetes at baseline. In patients without diabetes, empagliflozin did not lower HbA1c or increase the risk of hypoglycaemia or ketoacidosis. The safety of empagliflozin in patients with HFpEF was also consistent in patients both with and without diabetes.
These findings suggest that decisions regarding the use of empagliflozin for the treatment of HFpEF should not be driven by the glycaemic status of individual patients.