A 70-year-old woman presents to the office for a preventive visit. She has a history of type 2 diabetes mellitus (T2DM) treated with metformin with recent hemoglobin A1c concentration 7.5%. She has a sister who was recently hospitalized for heart failure (HF). The patient has atherosclerotic cardiovascular disease (ASCVD) but does not have known HF.
Her N-terminal pro–B-type natriuretic peptide (NT-proBNP) level is measured and found to be 250 pg/mL. She asks what she can do to minimize her risk of developing HF.
The addition of empagliflozin to her regimen will reduce this patient's risk of cardiovascular death but not of hospitalization for HF.
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The correct answer is: Fiction
The addition of empagliflozin to her regimen will decrease her risk of HF hospitalizations. In the EMPA-REG OUTCOME (Empagliflozin Cardiovascular Outcome Event Trial in Type 2 Diabetes Mellitus Patients) trial, investigators found that individuals with T2DM and ASCVD who were randomized to receive empagliflozin had a 35% relative risk reduction of HF hospitalization compared with individuals who received the placebo.1 Patients receiving empagliflozin also had a 38% relative risk reduction in death from cardiovascular causes and a 32% risk reduction in death from any cause.1
An NT-proBNP level >125 pg/mL also identifies the presence of "stage B" HF, as defined by the Universal Definition of HF.2 The American Diabetes Association (ADA) recommends yearly measurement of NT-proBNP or high-sensitivity troponin levels to identify the presence of unsuspected heart muscle disease in those with diabetes mellitus.3 Such patients are at high risk of symptomatic HF and should be treated with an sodium-glucose cotransporter-2 inhibitor as a preventive strategy.
Educational grant support provided by: Boehringer Ingelheim Pharmaceuticals Inc. (BIPI) and Lilly USA, LLC (Lilly). To visit the course page for the Heart Failure & SGLT2is: The New Pillar in Care grant,click here!
References
Zinman B, Wanner C, Lachin JM, et al. Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes. N Engl J Med 2015;373:2117-28.
Bozkurt B, Coats AJ, Tsutsui H, et al. Universal definition and classification of heart failure: a report of the Heart Failure Society of America, Heart Failure Association of the European Society of Cardiology, Japanese Heart Failure Society and Writing Committee of the Universal Definition of Heart Failure. J Card Fail 2021;27:387-413.
Pop-Busui R, Januzzi JL, Bruemmer D, et al. Heart failure: an underappreciated complication of diabetes. A consensus report of the American Diabetes Association. Diabetes Care 2022;45:1670-90.
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