How Does Empagliflozin Reduce Cardiovascular Mortality? Insights From a Mediation Analysis

Researchers reanalyzed a randomized trial, where treatments are assigned by chance, involving 7,020 adults with type 2 diabetes and existing heart disease. Participants took empagliflozin or a placebo, an inactive treatment, for about 3 years. Fewer people taking empagliflozin died from cardiovascular disease, meaning heart and blood vessel problems. A statistical mediation analysis, which estimates how changes may explain a treatment’s effects, suggested that fewer heart failure hospitalizations, lower uric acid, and higher hematocrit, the share of blood made up of red blood cells, explained much of the benefit. Changes in blood sugar, blood pressure, weight, and LDL cholesterol, often called bad cholesterol, did not appear to explain much of it.

What this means for you: This supports empagliflozin for people with type 2 diabetes and established heart disease when prescribed by a clinician. It does not prove exactly how the medicine works, and it is not a reason for healthy people to buy or take it for longer life.