Empagliflozin preserves kidney function in heart attack patients

Empagliflozin preserves kidney function in heart attack patients

Magazine: Nature cardiovascular research– June 13 online edition

Author:Deepak L. Bhatt, MD, MPH, MBA, Director of Mount Sinai Fuster Heart Hospital and Dr. Valentin Fuster Professor of Cardiovascular Medicine at the Icahn School of Medicine at Mount Sinai

Title:Secondary analysis of the Empact-MI experiment

Conclusion of studies:SGLT2 inhibitors have become an important drug used to treat diabetes, heart failure and chronic kidney disease. However, there have been questions about whether it is safe to use these drugs in patients after a recent heart attack because of concerns about damage to kidney function in potentially unstable patients.

This secondary analysis of the Empact-MI trial shows the SGLT2 inhibitor empagliflozin preserved renal function and was safe to initiate in heart attack patients. The researchers found that after heart attack patients were on the drug for two years, their kidney function was stable and intact, while patients on placebo had a significant decline in their kidney function.

Even in heart attack patients with poor kidney function, researchers found that SGLT2 inhibitors reduced heart failure complications. This is important considering that medications that are beneficial in patients without kidney disease sometimes do not work in patients with kidney disease. This was not the case with empagliflozin.

Why this study is important: Many heart attack patients who could benefit from SGLT2 inhibitors are currently not receiving the drugs because many doctors fear they could damage kidney function. Results from this study, the largest study to date of an SGLT2 inhibitor in patients with heart attacks, may change that.

How the research was conducted:Researchers randomized 6,522 patients hospitalized an average of five days after the heart attack to either an SGLT2 inhibitor or a placebo. Patients were followed for an average of one and a half years.

Study results:Empagliflozin reduced overall heart failure hospitalizations by 33 percent (2.4 events per 100 person-years in the empagliflozin group and 3.6 events per 100 person-years in the placebo group), with consistent effects by renal function. The difference in EGFR change (a measure of kidney function) between empagliflozin and placebo was 4.1 ml/min/1.73 m2), indicating a significant worsening of kidney function in the placebo group after two years.

What the study means for clinicians and patients: Clinicians should be vigilant when treating patients who may benefit from SGLT2 inhibitors and who do not withhold therapy due to a recent heart attack or kidney disease, as these study results indicate that these medications do not affect kidney function.

Quotes:"SGLT2 inhibitors are not used in clinical practice. These data reassure the safety of the use of this class of drugs when indicated in patients after a recent myocardial infarction and when renal function is impaired," says lead investigator Dr. Bhatt.

About the Empact-Mi study:Empact-Mi trial (Empagliflozin for the prevention of chronic heart failure and mortality after acute myocardial infarction, NCT04509674) is a multicenter, randomized, parallel-group, double-blind, placebo-controlled superiority study to investigate empagliflozin mortality, which contributed to mortality with a heartbeat in mortality. Participants did not have chronic heart failure and were eligible regardless of type 2 diabetes and chronic kidney disease status. Empact-Mi included more than 6,500 adults from 22 countries. Study participants were randomized to receive either 10 mg or placebo, once daily, in addition to standard of care within 14 days of hospital admission for heart attacks. The clinical trial in Empact-Mi was conducted by Boehringer Ingelheim in collaboration with the Duke Clinical Research Institute (DCRI), with Boehringer Ingelheim and Lilly providing funding. Key results from the Empact-MI trial were presented at the American College of Cardiology Annual Scientific Session, 8/6/2024, Atlanta and published in theNew England Journal of Medicine.

Financing:Boehringer Ingelheim financed the experiment and these analyses

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