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Cardiovascular Protection by Sodium Glucose Cotransporter 2 Inhibitors: Potential Mechanisms

Bart Staels1

  • 1Université Lille, INSERM, CHU Lille, Institut Pasteur de Lille, U1011-EGID, Lille, France.

The American Journal of Cardiology
|June 14, 2017
PubMed

Insights

The exact mechanism of empagliflozin

Area of Science:

  • Cardiovascular Medicine
  • Endocrinology
  • Pharmacology

Background:

  • The Empagliflozin Cardiovascular Outcome Event Trial in Type 2 Diabetes Mellitus Patients-Removing Excess Glucose (EMPA-REG OUTCOME) trial demonstrated reduced cardiovascular events with empagliflozin.
  • The precise mechanism underlying these benefits in patients with type 2 diabetes mellitus and high cardiovascular risk remains unclear.

Purpose of the Study:

  • To review and discuss the proposed mechanisms of action for empagliflozin in reducing cardiovascular outcomes.

Main Methods:

  • This review synthesizes current hypotheses regarding empagliflozin's effects.
  • It considers and evaluates potential antiatherosclerotic, hemodynamic, metabolic, and hormonal mechanisms.

Main Results:

  • An antiatherosclerotic effect is deemed unlikely due to the rapid reduction in cardiovascular mortality observed.
  • Hemodynamic effects (e.g., blood pressure reduction, osmotic diuresis) are considered more plausible.
  • Metabolic (cardiac energetics) and hormonal (glucagon release) effects may also contribute.

Conclusions:

  • The rapid cardiovascular benefits of empagliflozin suggest mechanisms beyond antiatherosclerosis.
  • Hemodynamic, metabolic, and hormonal pathways are likely contributors to its cardioprotective effects in type 2 diabetes.

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