Similarly, the CANVAS program demonstrated that in patients with type 2 diabetes mellitus and established or at high risk for atherosclerotic cardiovascular disease, reduced major cardiovascular events. The EMPA-REG OUTCOME trial demonstrated that in patients with type 2 diabetes mellitus and established atherosclerotic vascular disease, the SGLT2i empagliflozin reduced the composite outcomes of myocardial infarction, stroke, and cardiovascular death.
With the required inclusion of cardiovascular endpoints in trials of new pharmacotherapies for type 2 diabetes mellitus, two classes of agents, the sodium-glucose cotransporter 2 inhibitors (SGLT2i) and the glucagon-like peptide 1 receptor agonists (GLP1-RAs), have unexpectedly been found to reduce major cardiovascular events, including death. In patients with HFrEF on guideline-directed medical therapy, irrespective of whether T2DM is present or not, the addition of empagliflozin reduces cardiovascular mortality and hospitalization for progression of HF. In patients with HFrEF (defined by a left ventricular ejection fraction of 40% or less), does empagliflozin reduce CV mortality and the progression of HF compared to placebo?
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