Cardiovascular Benefit of Empagliflozin Across the Spectrum of Cardiovascular Risk Factor Control in the EMPA-REG OUTCOME Trial

Autor: Bernard Zinman, Michaela Mattheus, Silvio E. Inzucchi, Jyothis T. George, Kamlesh Khunti, Anne Pernille Ofstad, David Fitchett, Christoph Wanner
Rok vydání: 2020
Předmět:
Blood Glucose
Male
Endocrinology
Diabetes and Metabolism
cardioprotective
Clinical Biochemistry
Type 2 diabetes
Cardiovascular System
Biochemistry
chemistry.chemical_compound
Endocrinology
Glucosides
Risk Factors
cardiovascular disease
Medicine
education.field_of_study
Hazard ratio
Middle Aged
Hospitalization
Treatment Outcome
Cardiovascular Diseases
Female
type 2 diabetes
AcademicSubjects/MED00250
medicine.medical_specialty
Cardiotonic Agents
Population
Context (language use)
Risk Assessment
Internal medicine
Post-hoc analysis
Empagliflozin
Humans
Benzhydryl Compounds
Risk factor
education
Clinical Research Articles
Aged
Retrospective Studies
Glycated Hemoglobin
Heart Failure
business.industry
Biochemistry (medical)
medicine.disease
Diabetes Mellitus
Type 2
chemistry
Heart Disease Risk Factors
Glycated hemoglobin
business
Follow-Up Studies
Zdroj: The Journal of Clinical Endocrinology and Metabolism
ISSN: 1945-7197
0021-972X
Popis: Context Control of multiple cardiovascular (CV) risk factors reduces CV events in individuals with type 2 diabetes. Objective To investigate this association in a contemporary clinical trial population, including how CV risk factor control affects the CV benefits of empagliflozin, a sodium-glucose cotransporter-2 inhibitor. Design Post hoc analysis. Setting Randomized CV outcome trial (EMPA-REG OUTCOME). Participants Type 2 diabetes patients with established CV disease. Intervention Empagliflozin or placebo. Main Outcome Measures Risk of CV outcomes—including the treatment effect of empagliflozin—by achieving 7 goals for CV risk factor control at baseline: (1) glycated hemoglobin Results In the placebo group, the hazard ratio (HR) for CV death was 4.00 (95% CI, 2.26–7.11) and 2.48 (95% CI, 1.52–4.06) for patients achieving only 0–3 or 4–5 risk factor goals at baseline, respectively, compared with those achieving 6–7 goals. Participants achieving 0–3 or 4–5 goals also had increased risk for the composite outcome of hospitalization for heart failure or CV death (excluding fatal stroke) (HR 2.89 [1.82–4.57] and 1.90 [1.31–2.78], respectively) and 3-point major adverse CV events (HR 2.21 [1.53–3.19] and 1.42 [1.06–1.89]). Empagliflozin significantly reduced these outcomes across all risk factor control categories (P > 0.05 for treatment-by-subgroup interactions). Conclusions Cardiovascular risk in EMPA-REG OUTCOME was inversely associated with baseline CV risk factor control. Empagliflozin’s cardioprotective effect was consistent regardless of multiple baseline risk factor control.
Databáze: OpenAIRE
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