Sodium-glucose cotransporter-2 inhibition for the reduction of cardiovascular events in high-risk patients with diabetes mellitus

Publication date: Available online 1 September 2018Source: Indian Heart JournalAuthor(s): A.K. PancholiaAbstractPatients with type 2 diabetes mellitus (T2DM) exhibit an increased risk for cardiovascular (CV) events. Hyperglycemia itself contributes to the pathogenesis of atherosclerosis and heart failure (HF) in these patients, but glucose-lowering strategies studied to date have had little or no impact on reducing CV risk, especially in patients with a long duration of T2DM and prevalent CV disease (CVD). Sodium glucose cotransporter-2 (SGLT2)-inhibitors are the new class of glucose lowering medications that increase urinary glucose excretion, thus improving glycemic control independent of insulin. The recently published CV outcome trial- Empagliflozin Cardiovascular Outcome Event Trial in Type 2 Diabetes Mellitus Patients- Removing Excess Glucose (EMPA-REG OUTCOME)- demonstrated that the SGLT2-inhibitor empagliflozin significantly reduced the combined CV endpoint of CV death, non-fatal myocardial infarction, and non-fatal stroke vs. placebo in a population of patients with T2DM and prevalent atherosclerotic CVD. In addition, and quite unexpectedly, empagliflozin significantly and robustly reduced the individual endpoints of CV death, overall mortality, and hospitalization for HF in this high-risk population. Several beneficial factors beyond glucose control such as weight loss, lowering blood pressure, sodium depletion, renal hemodynamic effects, effects on myocardial e...
Source: Indian Heart Journal - Category: Cardiology Source Type: research