The Use of Empagliflozin Post Myocardial Infarction

Overview

Journal Cureus

Specialty Biomedical Engineering

Date 2023 Jul 20

PMID 37469808

Authors

Kapilraj Ravendran

Nikolaos Madouros

Edzhem Yoztyurk

Aishwarya Wilson

Maria J Jeejo

Monica E Camelio

Akatya Sinha

Ananya George

Mriganka Rai

Hussain K Malik

Affiliations

Soon will be listed here.

Abstract

Empagliflozin is a sodium-glucose cotransporter 2 (SGLT2) inhibitor that is mainly used for the treatment of type 2 diabetes mellitus. The study's objective was to assess empagliflozin's effects and impacts on post-myocardial patients to highlight its worth in comparison to alternative therapies. Only studies evaluating the effects of empagliflozin on individuals who have undergone a myocardial infarction (MI) are included in this review of the literature, which employed PubMed, Google Scholar, and Embase. To compare the advantages of empagliflozin for individuals who have recently experienced a myocardial infarction, abstracts from pertinent articles were retrieved, and complete publications were reviewed. A total of four articles were reviewed, which showed that in patients who suffered from a recent MI, empagliflozin caused a significant decrease in N-terminal pro-brain natriuretic peptide (NT-proBNP). Additionally, it was shown that these individuals had better echocardiographic results for both structural and functional metrics. With studies showing a significantly larger median NT-proBNP decrease with empagliflozin compared to placebo among patients hospitalised with an acute big MI when empagliflozin was started early and administered in addition to the post-MI care suggested by guidelines, it is safe to say that the benefits outweigh the risks. There are currently larger double-blind trials in progress to prove the hypothesis of the benefits of empagliflozin for post-MI patients.

Citing Articles

Empagliflozin demonstrates neuroprotective and cardioprotective effects by reducing ischemia/reperfusion damage in rat models of ischemic stroke and myocardial infarction.

Dai W, Alavi R, Li J, Carreno J, Pahlevan N, Kloner R Sci Rep. 2025; 15(1):8986.

PMID: 40089564 DOI: 10.1038/s41598-025-93483-7.

References

Chew D, Heikki H, Schmidt G, Kavanagh K, Dommasch M, Thomsen P . Change in Left Ventricular Ejection Fraction Following First Myocardial Infarction and Outcome. JACC Clin Electrophysiol. 2018; 4(5):672-682. DOI: 10.1016/j.jacep.2017.12.015. View

Januzzi Jr J, Butler J, Zannad F, Filippatos G, Ferreira J, Pocock S . Prognostic Implications of N-Terminal Pro-B-Type Natriuretic Peptide and High-Sensitivity Cardiac Troponin T in EMPEROR-Preserved. JACC Heart Fail. 2022; 10(7):512-524. DOI: 10.1016/j.jchf.2022.05.004. View

Jiang K, Xu Y, Wang D, Chen F, Tu Z, Qian J . Cardioprotective mechanism of SGLT2 inhibitor against myocardial infarction is through reduction of autosis. Protein Cell. 2021; 13(5):336-359. PMC: 9008115. DOI: 10.1007/s13238-020-00809-4. View

Requena-Ibanez J, Santos-Gallego C, Rodriguez-Cordero A, Vargas-Delgado A, Mancini D, Sartori S . Mechanistic Insights of Empagliflozin in Nondiabetic Patients With HFrEF: From the EMPA-TROPISM Study. JACC Heart Fail. 2021; 9(8):578-589. DOI: 10.1016/j.jchf.2021.04.014. View

Januzzi Jr J, Zannad F, Anker S, Butler J, Filippatos G, Pocock S . Prognostic Importance of NT-proBNP and Effect of Empagliflozin in the EMPEROR-Reduced Trial. J Am Coll Cardiol. 2021; 78(13):1321-1332. DOI: 10.1016/j.jacc.2021.07.046. View

Goerg J, Sommerfeld M, Greiner B, Lauer D, Seckin Y, Kulikov A . Low-Dose Empagliflozin Improves Systolic Heart Function after Myocardial Infarction in Rats: Regulation of MMP9, NHE1, and SERCA2a. Int J Mol Sci. 2021; 22(11). PMC: 8196699. DOI: 10.3390/ijms22115437. View

Lam C, Chandramouli C, Ahooja V, Verma S . SGLT-2 Inhibitors in Heart Failure: Current Management, Unmet Needs, and Therapeutic Prospects. J Am Heart Assoc. 2019; 8(20):e013389. PMC: 6818035. DOI: 10.1161/JAHA.119.013389. View

Shimizu W, Kubota Y, Hoshika Y, Mozawa K, Tara S, Tokita Y . Effects of empagliflozin versus placebo on cardiac sympathetic activity in acute myocardial infarction patients with type 2 diabetes mellitus: the EMBODY trial. Cardiovasc Diabetol. 2020; 19(1):148. PMC: 7519555. DOI: 10.1186/s12933-020-01127-z. View

Packer M, Anker S, Butler J, Filippatos G, Pocock S, Carson P . Cardiovascular and Renal Outcomes with Empagliflozin in Heart Failure. N Engl J Med. 2020; 383(15):1413-1424. DOI: 10.1056/NEJMoa2022190. View

10.

Januzzi Jr J, Xu J, Li J, Shaw W, Oh R, Pfeifer M . Effects of Canagliflozin on Amino-Terminal Pro-B-Type Natriuretic Peptide: Implications for Cardiovascular Risk Reduction. J Am Coll Cardiol. 2020; 76(18):2076-2085. DOI: 10.1016/j.jacc.2020.09.004. View

11.

Lopaschuk G, Verma S . Mechanisms of Cardiovascular Benefits of Sodium Glucose Co-Transporter 2 (SGLT2) Inhibitors: A State-of-the-Art Review. JACC Basic Transl Sci. 2020; 5(6):632-644. PMC: 7315190. DOI: 10.1016/j.jacbts.2020.02.004. View

12.

Requena-Ibanez J, Santos-Gallego C, Rodriguez-Cordero A, Vargas-Delgado A, Badimon J . Empagliflozin improves quality of life in nondiabetic HFrEF patients. Sub-analysis of the EMPATROPISM trial. Diabetes Metab Syndr. 2022; 16(2):102417. DOI: 10.1016/j.dsx.2022.102417. View

13.

Ferrannini G, Savarese G, Ryden L . Sodium-glucose transporter inhibition in heart failure: from an unexpected side effect to a novel treatment possibility. Diabetes Res Clin Pract. 2021; 175:108796. DOI: 10.1016/j.diabres.2021.108796. View

14.

Butler J, Packer M, Filippatos G, Ferreira J, Zeller C, Schnee J . Effect of empagliflozin in patients with heart failure across the spectrum of left ventricular ejection fraction. Eur Heart J. 2021; 43(5):416-426. PMC: 8825259. DOI: 10.1093/eurheartj/ehab798. View

15.

Page M, McKenzie J, Bossuyt P, Boutron I, Hoffmann T, Mulrow C . The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Syst Rev. 2021; 10(1):89. PMC: 8008539. DOI: 10.1186/s13643-021-01626-4. View

16.

Verma S, McMurray J . SGLT2 inhibitors and mechanisms of cardiovascular benefit: a state-of-the-art review. Diabetologia. 2018; 61(10):2108-2117. DOI: 10.1007/s00125-018-4670-7. View

17.

von Lewinski D, Kolesnik E, Tripolt N, Pferschy P, Benedikt M, Wallner M . Empagliflozin in acute myocardial infarction: the EMMY trial. Eur Heart J. 2022; 43(41):4421-4432. PMC: 9622301. DOI: 10.1093/eurheartj/ehac494. View

18.

Anker S, Butler J, Filippatos G, Ferreira J, Bocchi E, Bohm M . Empagliflozin in Heart Failure with a Preserved Ejection Fraction. N Engl J Med. 2021; 385(16):1451-1461. DOI: 10.1056/NEJMoa2107038. View

19.

Lundin M, Ferrannini G, Mellbin L, Johansson I, Norhammar A, Nasman P . SOdium-glucose CO-transporter inhibition in patients with newly detected Glucose Abnormalities and a recent Myocardial Infarction (SOCOGAMI). Diabetes Res Clin Pract. 2022; 193:110141. DOI: 10.1016/j.diabres.2022.110141. View

20.

Verma S, Mazer C, Yan A, Mason T, Garg V, Teoh H . Effect of Empagliflozin on Left Ventricular Mass in Patients With Type 2 Diabetes Mellitus and Coronary Artery Disease: The EMPA-HEART CardioLink-6 Randomized Clinical Trial. Circulation. 2019; 140(21):1693-1702. DOI: 10.1161/CIRCULATIONAHA.119.042375. View