The diabetes world was stunned and delighted in 2015 when the diabetes medication empagliflozin (Jardiance) was proven to reduce cardiovascular death by a whopping 38%. This was an unexpected finding, as no diabetes medication had ever before been shown to decrease the risk of cardiovascular events. The protective ability of empagliflozin starts very early, suggesting that it is not an effect on atherosclerosis (hardening of the arteries) per se, as this process takes a longer time. It has been a puzzle to understand exactly what is behind the protective abilities of empagliflozin.
hematocrit, fasting blood sugar, uric acid, and protein in the urine (urine albumin:creatinine ratio) mediated most of the beneficial effect of empaglifozin.So, we learn what we suspected – that there are multiple and complex mechanisms at play by which empagliflozin reduces cardiovascular risk. There may well be additional mechanisms at play that were not measured, or measurable, in the EMPA REG study.
also been shown to protect against cardiovascular events, but canaglifozin was also found to increase the risk of amputations and bone fracture. Two medications of a different class (GLP1 receptor agonists), called liraglutide (Victoza) and semaglutide (Ozempic) also have a protective benefit.
Disclaimer: I receive honoraria as as continuing medical education speaker and consultant from the makers of empagliflozin (Boehringer-Ingelheim and Eli Lilly), canagliflozin (Janssen), liraglutide and semaglutide (Novo Nordisk). I am involved in research of SGLT2 inhibitors and GLP1 receptor agonists as treatments for diabetes.
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