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Empagliflozin reduces mortality and hospitalisation for heart failure irrespective of cardiovascular risk score at baseline

Session Poster Session 2

Speaker David Fitchett

Congress : ESC Congress 2018

  • Topic : cardiovascular pharmacology
  • Sub-topic : Anti-Diabetic Pharmacotherapy
  • Session type : Poster Session
  • FP Number : P1879

Authors : D Fitchett (Toronto,CA), SE Inzucchi (New Haven,US), CP Cannon (Boston,US), DK Mcguire (Dallas,US), OE Johansen (Asker,NO), S Sambevski (Ingelheim,DE), U Hehnke (Ingelheim,DE), J George (Ingelheim,DE), B Zinman (Toronto,CA)

Authors:
D. Fitchett1 , S.E. Inzucchi2 , C.P. Cannon3 , D.K. McGuire4 , O.E. Johansen5 , S. Sambevski6 , U. Hehnke6 , J. George6 , B. Zinman7 , 1St Michael's Hospital, Division of Cardiology, University of Toronto - Toronto - Canada , 2Yale University, Section of Endocrinology - New Haven - United States of America , 3Cardiovascular Division, Brigham and Women's Hospital - Boston - United States of America , 4University of Texas Southwestern Medical School - Dallas - United States of America , 5Boehringer Ingelheim Norway KS - Asker - Norway , 6Boehringer Ingelheim International GmbH - Ingelheim - Germany , 7Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, University of Toronto - Toronto - Canada ,

Citation:
European Heart Journal ( 2018 ) 39 ( Supplement ), 400-401

Background: In the EMPA-REG OUTCOME trial in patients with type 2 diabetes and established cardiovascular (CV) disease, empagliflozin added to standard of care reduced CV death vs placebo by 38% (HR 0.62 [95% CI 0.49, 0.77]), all-cause death by 32% (HR 0.68 [95% CI 0.57, 0.82]) and hospitalisation for heart failure (HHF) by 35% (HR 0.65 [95% CI 0.50, 0.85]). We investigated whether residual CV risk at baseline influenced the effect of empagliflozin on these outcomes.

Methods: We investigated CV death, all-cause death, HHF and the composite of HHF or CV death with empagliflozin vs placebo in subgroups by degree of CV risk at baseline based on the 10-point TIMI Risk Score for Secondary Prevention (TRS 2°P). P-values for treatment-by-subgroup interaction were obtained from tests of homogeneity of treatment group differences among subgroups with no adjustment for multiple testing.

Results: Based on the TRS 2°P risk score, of 7020 patients who received study drug in the EMPA-REG OUTCOME trial, 12%, 40%, 30% and 18% were at low, intermediate, high and highest residual CV risk, respectively, at baseline. In the placebo group, from low to highest predicted risk, the proportion of patients with CV death increased from 2.2% to 11.2% and the proportion of patients with HHF increased from 1.1% to 10.0%. Effects of empagliflozin on CV death, all-cause death, HHF and HHF or CV death were consistent across subgroups by baseline CV risk score (Figure).

Conclusion: The benefits of empagliflozin on key clinical outcomes in the EMPA-REG OUTCOME trial occurred irrespective of residual CV risk at baseline.

The free consultation period for this content is over.

It is now only available year-round to ESC Professional Members, Fellows of the ESC, and Young combined Members



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