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Adults with type 2 diabetes and established cardiovascular disease: American College of Cardiology recommends Empagliflozin as preferred SGLT2 inhibitor


A new Expert Consensus Decision Pathway issued by the American College of Cardiology ( ACC ) has recommended Empagliflozin ( Jardiance ) as the preferred SGLT2 inhibitor for its proven benefit in reducing the risk of cardiovascular death in adults with type 2 diabetes and established cardiovascular disease.

The recommendation of Empagliflozin is based on evidence from the landmark EMPA-REG OUTCOME trial, which investigated the effects of Empagliflozin compared with placebo when added to standard of care in adults with type 2 diabetes and established cardiovascular disease.

In addition to the ACC Expert Consensus Decision Pathway, the American Diabetes Association ( ADA ) and European Association for the Study of Diabetes ( EASD ) recently published a Consensus Report recommending SGLT2 inhibitors, such as Empagliflozin, to help manage cardiovascular outcomes in patients with type 2 diabetes.

Empagliflozin is also the only SGLT2 inhibitor recommended in the ADA 2018 Standards of Medical Care in Diabetes for reducing the risk of cardiovascular death in people with type 2 diabetes and established cardiovascular disease.

People with type 2 diabetes mellitus are at increased risk of serious cardiovascular complications and events, even when their blood sugar is under control, which is why a focus on reducing cardiovascular risk in people with diabetes is critical.

EMPA-REG OUTCOME was a long-term, multicenter, randomised, double-blind, placebo-controlled trial of more than 7,000 patients from 42 countries with type 2 diabetes and established cardiovascular disease.
The study assessed the effect of Empagliflozin ( 10 mg or 25 mg once daily ) added to standard of care compared with placebo added to standard of care.
Standard of care was comprised of glucose-lowering agents and cardiovascular drugs ( including for blood pressure and cholesterol ).
The primary endpoint was defined as time to first occurrence of cardiovascular death, non-fatal myocardial infarction or non-fatal stroke.
The overall safety profile of Empagliflozin was consistent with that of previous trials.

Empagliflozin is an oral, once daily, highly selective sodium glucose cotransporter 2 ( SGLT2 ) inhibitor.
Inhibition of SGLT2 with Empagliflozin in people with type 2 diabetes and high blood sugar levels leads to excretion of excess sugar in the urine.
In addition, initiation of Empagliflozin increases excretion of salt from the body and reduces the fluid load of the body’s blood vessel system ( i.e. intravascular volume ).
Empagliflozin induces changes to the sugar, salt and water metabolism in the body that may contribute to the reductions in cardiovascular death observed in the EMPA-REG OUTCOME trial.

More than 425 million people worldwide have diabetes, of which over 212 million are estimated to be undiagnosed.
Type 2 diabetes is the most common form of diabetes, responsible for around 90% of diabetes cases in high-income countries.
Due to the complications associated with diabetes, such as high blood sugar, high blood pressure and obesity, cardiovascular disease is a major complication and the leading cause of death associated with diabetes.
People with diabetes are two to four times more likely to develop cardiovascular disease than people without diabetes.
In 2017, diabetes caused four million deaths worldwide, with cardiovascular disease as the leading cause. Approximately 50% of deaths in people with type 2 diabetes worldwide are caused by cardiovascular disease.

Having a history of diabetes at age 60 can shorten a person’s life span by as much as six years compared with someone without diabetes. And having both diabetes and a history of myocardial infarction or stroke by age 60 can shorten a person’s life span by as much as 12 years compared with someone without these conditions. ( Xagena )

Source: Boehringer Ingelheim & Lilly Diabetes, 2018

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