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Cardiovascular and Renal Outcomes with Empagliflozin in Heart Failure
Open accessAbstract
BACKGROUNDSodium-glucose cotransporter 2 (SGLT2) inhibitors reduce the risk of hospitalization for heart failure in patients regardless of the presence or absence of diabetes.More evidence is needed regarding the effects of these drugs in patients across the broad spectrum of heart failure, including those with a markedly reduced ejection fraction. METHODSIn this double-blind trial, we randomly assigned 3730 patients with class II, III, or IV heart failure and an ejection fraction of 40% or less to receive empagliflozin (10 mg once daily) or placebo, in addition to recommended therapy.The primary outcome was a composite of cardiovascular death or hospitalization for worsening heart failure. RESULTSDuring a median of 16 months, a primary outcome event occurred in 361 of 1863 patients (19.4%) in the empagliflozin group and in 462 of 1867 patients (24.7%) in the placebo group (hazard ratio for cardiovascular death or hospitalization for heart failure, 0.75; 95% confidence interval [CI], 0.65 to 0.86; P<0.001).The effect of empagliflozin on the primary outcome was consistent in patients regardless of the presence or absence of diabetes.The total number of hospitalizations for heart failure was lower in the empagliflozin group than in the placebo group (hazard ratio, 0.70; 95% CI, 0.58 to 0.85; P<0.001).The annual rate of decline in the estimated glomerular filtration rate was slower in the empagliflozin group than in the placebo group (-0.55 vs. -2.28ml per minute per 1.73 m 2 of body-surface area per year, P<0.001), and empagliflozin-treated patients had a lower risk of serious renal outcomes.Uncomplicated genital tract infection was reported more frequently with empagliflozin. CONCLUSIONSAmong patients receiving recommended therapy for heart failure, those in the empagliflozin group had a lower risk of cardiovascular death or hospitalization for heart failure than those in the placebo group, regardless of the presence or absence of diabetes.(Funded by Boehringer Ingelheim and Eli Lilly; EMPEROR-Reduced ClinicalTrials.govnumber, NCT03057977.
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In the citing paper
“Subgroup analyses from DAPA-CKD (117) and analyses from the EMPEROR heart failure trials suggest that SGLT2 inhibitors are safe and effective at eGFR levels of >20 mL/min/1.73m 2 .”
From 11. Chronic Kidney Disease and Risk Management: Standards of Care in Diabetes—2025 (2025) · cites this paper as [119]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Direct evidence is provided by the DAPA-CKD, SCORED, EMPEROR-Reduced, and EMPEROR-Preserved trials, which enrolled such participants by design.”
From KDIGO 2022 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease (2022) · cites this paper as [101]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“However, notably, SGLT2i have been studied among patients without T2D who have CKD in the DAPA-CKD trial (and the soonto-be-published EMPA-KIDNEY trial) or who have heart failure (in the DAPA-HF, EMPEROR-Reduced, and EMPEROR-Preserved trials) and did not confer any increased risk of severe hypoglycemia or diabetic ketoacidosis among individuals without T2D.”
From KDIGO 2022 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease (2022) · cites this paper as [101]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“enrollment criteria included eGFR >60 mL/min/1.73m 2 , but efficacy was seen at eGFR >20 mL/min/1.73m 2 in people with heart failure.”
From 11. Chronic Kidney Disease and Risk Management: Standards of Care in Diabetes—2026 (2026) · cites this paper as [135]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“SGLT2 inhibitors reduce the incidence of heart failure and improve heart failurerelated outcomes, including hospitalization for heart failure and heart failure-related symptoms, in people with diabetes with preserved or reduced ejection fraction (250,(255)(256)(257)(298)(299)(300)(301)(302)(303)(304)(305)(306).”
From 10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes—2025 (2025) · cites this paper as [303]
Experimental — accuracy not yet measured
The source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“and the Empagliflozin Outcome Trial in Patients With Chronic Heart Failure (EMPEROR) trials (which provided clear evidence of efficacy and safety for empagliflozin among patients with eGFR ≥20 mL/min/1.73 m2 and HF) (54,57,58).”
From Diabetes management in chronic kidney disease: a consensus report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO) (2022) · cites this paper as [58]
Experimental — accuracy not yet measuredThe cited source says what the claim attributes to it.
In the citing paper
“Clinical trials, such as EMPEROR-REDUCED (empagliflozin) and DAPA-CKD (dapagliflozin), have shown that SGLT-2 inhibitors have benefits in patients with heart failure and chronic kidney disease, regardless of the presence of diabetes.38,39”
From Tirzepatide: Clinical review of the twincretin injectable (2023) · cites this paper as [39]
The cited source says what the claim attributes to it.
In the citing paper
“The primary outcome among those with an eGFR $ 60 ml/min per 1.73 m 2 was HR: 0.67; 95% CI: 0.55 -0.83 and for those with eGFR < 60 ml/min per 1.73 m 2 was HR: 0.83; 95% CI: 0.69 -1.00.”
From KDIGO 2022 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease (2022) · cites this paper as [101]
The cited source says what the claim attributes to it.
In the citing paper
“As seen in DAPA-HF, the primary outcome was similarly reduced for individuals with and without diabetes.”
From KDIGO 2022 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease (2022) · cites this paper as [101]
The cited source says what the claim attributes to it.
In the citing paper
“the primary outcome of cardiovascular death or heart failure hospitalization occurred in 19.4% of the empagli fl ozin group and 24.7% of the placebo group (HR: 0.75; 95% CI: 0.65 -0.86).”
From KDIGO 2022 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease (2022) · cites this paper as [101]
The cited source says what the claim attributes to it.
In the citing paper
“A composite kidney outcome HR of 0.50 (95% CI: 0.32 -0.77) was also reported.”
From KDIGO 2022 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease (2022) · cites this paper as [101]
The cited source says what the claim attributes to it.
In the citing paper
“Similar results were obtained in clinical trials with empagliflozin (303).”
From 10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes—2025 (2025) · cites this paper as [303]
The cited source says what the claim attributes to it.
In the citing paper
“Similar results were obtained in clinical trials with empagliflozin (291).”
From 10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes—2026 (2026) · cites this paper as [291]
The check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“The EMPEROR-Reduced 101 and EMPEROR-Preserved 102 trials, although not an exclusive CKD population, did allow enrollment of patients with an eGFR as low as 20 ml/min per 1.73 m 2.”
From KDIGO 2022 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease (2022) · cites this paper as [101]
Experimental — accuracy not yet measuredThe check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“The EMPA-REG trial enrolled over 7000 patients with T2D, baseline glycated hemoglobin (HbA1c) of 7% -10%, established CVD (almost 100%), and an eGFR of at least 30 ml/min per 1.73 m 2 . 101”
From KDIGO 2022 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease (2022) · cites this paper as [101]
Experimental — accuracy not yet measuredThe check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“The EMPEROR-Reduced and EMPEROR-Preserved trials, although not exclusive CKD populations, did allow enrollment participants with an eGFR as low as 20 ml/min per 1.73 m 2 .”
From KDIGO 2022 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease (2022) · cites this paper as [101]
Experimental — accuracy not yet measuredIn the citing paper
“The EMPEROR-Reduced (Empagliflozin Outcome Trial in Patients With Chronic Heart Failure With Reduced Ejection Fraction) trial demonstrated a benefit of SGLT2 inhibition with empagliflozin to reduce both the risk and rate of heart failure hospitalizations.7”
From Effect of Empagliflozin on the Clinical Stability of Patients With Heart Failure and a Reduced Ejection Fraction: The EMPEROR-Reduced Trial (2021) · cites this paper as [7]
In the citing paper
“Sodium-glucose cotransporter 2 (SGLT2) inhibitors have been shown to reduce the risk of hospitalizations for heart failure in 8 large-scale trials, including those that focused on type 2 diabetes, heart failure with a reduced ejection fraction, and chronic kidney disease.1–8”
From Effect of Empagliflozin on the Clinical Stability of Patients With Heart Failure and a Reduced Ejection Fraction: The EMPEROR-Reduced Trial (2021) · cites this paper as [7]
In the citing paper
“As previously reported,7 the 2 groups comprised patients with mild, moderate, and severe heart failure, as reflected by left ventricular ejection fraction and circulating levels of NT-proBNP, and were well-balanced with respect to baseline characteristics.”
From Effect of Empagliflozin on the Clinical Stability of Patients With Heart Failure and a Reduced Ejection Fraction: The EMPEROR-Reduced Trial (2021) · cites this paper as [7]
In the citing paper
“In the EMPEROR-Reduced trial, empagliflozin reduced the risk of cardiovascular death or hospitalization for heart failure, a benefit that was driven primarily by an effect of the drug to reduce first and recurrent admissions for worsening heart failure.7”
From Effect of Empagliflozin on the Clinical Stability of Patients With Heart Failure and a Reduced Ejection Fraction: The EMPEROR-Reduced Trial (2021) · cites this paper as [7]
In the citing paper
“In our original publication and in a meta-analysis of the DAPA-HF and EMPEROR-Reduced trials, we noted a somewhat lesser benefit in patients with ejection fraction of 31% to 40% and in patients with class III symptoms.”
From Effect of Empagliflozin on the Clinical Stability of Patients With Heart Failure and a Reduced Ejection Fraction: The EMPEROR-Reduced Trial (2021) · cites this paper as [7]
In the citing paper
“Rates of worsening heart failure or cardiovascular death are lower among patients with heart failure who are treated with dapagliflozin and empagliflozin regardless of diabetes diagnosis.7,8”
From Association of race/ethnicity, gender, and socioeconomic status with sodium-glucose cotransporter 2 inhibitor use among patients with diabetes in the US (2021) · cites this paper as [8]
In the citing paper
“As for the morbidity, renal outcome and HHF, it was clear that SGLT-2i had more significant impact than finerenone, which might be explained by the special potency of SGLT-2i such as reducing blood glucose, reducing oxidative stress, losing weight, reducing uric acid, controlling blood pressure and improving renal ultrafiltration and hypoxia [65, 71–79].”
In the citing paper
“Multiple SGLT2i trials included subsets of participants without diabetes, who appear to have derived similar benefits as those with T2D, 8,14,18”
In the citing paper
“Treatment with empagliflozin improved quality of life.496”
From 2023 ESC guidelines for the management of cardiovascular disease in patients with diabetes. (2023) · cites this paper as [496]
In the citing paper
“The risk of a prespeci fi ed renal composite outcome (chronic dialysis, renal transplantation, or a sustained reduction in eGFR) was lower in the empagli fl ozin group than in the placebo group (1.6% in the empaglifl ozin group vs. 3.1% in the placebo group; HR 0.50 [95% CI 0.32 -0.77]).”
From 10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes—2023 (2023) · cites this paper as [200]
In the citing paper
“Over a median follow-up of 16 months, those in the empagli fl ozin-treated group had a reduced risk of the primary outcome (HR 0.75 [95% CI 0.65 -0.86]; P < 0.001) and fewer total hospitalizations for heart failure (HR 0.70 [95% CI 0.58 -0.85]; P < 0.001).”
From 10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes—2023 (2023) · cites this paper as [200]
In the citing paper
“Over a median follow-up of 16 months, those in the empagli fl ozin-treated group had a reduced risk of the primary outcome (HR 0.75 [95% CI 0.65 -0.86]; P < 0.001) and fewer total hospitalizations for heart failure (HR 0.70 [95% CI 0.58 -0.85]; P < 0.001).”
From 10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes—2023 (2023) · cites this paper as [200]
In the citing paper
“The effect of empagli fl ozin on the primary outcome was consistent irrespective of diabetes diagnosis at baseline.”
From 10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes—2023 (2023) · cites this paper as [200]
In the citing paper
“Moreover, in the recent EMPEROR-Reduced trial (Empagliflozin Outcome Trial in Patients with Chronic Heart Failure and a Reduced Ejection Fraction), SGLT2 inhibition did reduce renal events significantly, although that trial used a different renal composite outcome and had more renal events than in DAPA-HF (88 versus 67).”
From Efficacy of Dapagliflozin on Renal Function and Outcomes in Patients With Heart Failure With Reduced Ejection Fraction: Results of DAPA-HF (2021) · cites this paper as [21]
In the citing paper
“More recently, in a large trial using empagliflozin in patients with HFrEF, the rate of decline in eGFR was 2.28 (SD 0.23) mL·min–1·1.73 m–2 per year, which was reduced to 0.55 (0.23) in the SGLT2 inhibitor group.21”
From Efficacy of Dapagliflozin on Renal Function and Outcomes in Patients With Heart Failure With Reduced Ejection Fraction: Results of DAPA-HF (2021) · cites this paper as [21]
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“1 9,20 Despite procedural success of AVR/TAVI, a substantial number of TAVI recipients face HF-related hospitalization within the first year post-TAVI, leading to a notable increase in long-term mortality and health care costs.”
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Self-citationSodium-Glucose Cotransporter 2 Inhibitors and Cardiac Remodeling
Salah, H. M., Verma, S., Santos‐Gallego, C. G., Bhatt, A. S., Vaduganathan, M., Khan, M. S., Lópes, R. D., Alaref, S. J., McGuire, D. K., & Fudim, M. (2022) · Journal of Cardiovascular Translational Research · doi:10.1007/s12265-022-10220-5 · Cited by 52
“The EMPERORReduced (EMPagliflozin outcomE tRial in Patients With chrOnic heaRt Failure With Reduced Ejection Fraction) [14] and DAPA-HF (Dapagliflozin and Prevention of Adverse Outcomes in Heart Failure) [15] trials have confirmed CV benefits of SGLT2 inhibitors in patients with HF with reduced ejection fraction (HFrE…”
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SGLT2 Inhibitors in Chronic Kidney Disease: From Mechanisms to Clinical Practice
Škrabić, R., Kumrić, M., Vrdoljak, J., Rušić, D., Skrabic, I., Vilović, M., Martinović, D., Duplancic, V., Kurir, T. T., & Božić, J. (2022) · Biomedicines · doi:10.3390/biomedicines10102458 · Cited by 51
Cherney, D. Z. I., Ferrannini, E., Umpierrez, G. E., Peters, A. L., Rosenstock, J., Powell, D. R., Davies, M. J., Banks, P. L., & Agarwal, R. (2023) · Diabetes Obesity and Metabolism · doi:10.1111/dom.15019 · Cited by 51
Prescription Patterns for Sodium-Glucose Cotransporter 2 Inhibitors in U.S. Health Systems
Shin, J., Xu, Y., Chang, A. R., Carrero, J. J., Flaherty, C. M., Mukhopadhyay, A., Inker, L. A., Blecker, S., Horwitz, L. I., & Grams, M. E. (2024) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2024.05.057 · Cited by 58
Qiu, M., Ding, L., Zhan, Z., & Liu, S.-Y. (2021) · Endocrine · doi:10.1007/s12020-021-02644-x · Cited by 49
Sharma, A., Mah, M., Ritchie, R. H., & Blasio, M. J. D. (2021) · Pharmacology & Therapeutics · doi:10.1016/j.pharmthera.2021.108008 · Cited by 52
Cherney, D. Z. I., Udell, J. A., & Drucker, D. J. (2021) · Med · doi:10.1016/j.medj.2021.10.004 · Cited by 54
SGLT2 Inhibitors and Their Antiarrhythmic Properties
Kolesnik, E., Scherr, D., Rohrer, U., Benedikt, M., Manninger, M., Sourij, H., & von Lewinski, D. (2022) · International Journal of Molecular Sciences · doi:10.3390/ijms23031678 · Cited by 56
“The same is true for empagliflozin in patients with reduced [11] and preserved ejection fraction [12].”
BackgroundTsai, W.-C., Hsu, S.-P., Chiu, Y.-L., Yang, J.-Y., Pai, M.-F., Ko, M.-J., Tu, Y.-K., Hung, K.-Y., Chien, K.-L., Peng, Y.-S., et al. (2022) · BMJ Open · doi:10.1136/bmjopen-2021-060655 · Cited by 53
Sodium-Glucose Cotransporter 2 Inhibitors in Patients with Non-Diabetic Chronic Kidney Disease
Mima, A. (2021) · Advances in Therapy · doi:10.1007/s12325-021-01735-5 · Cited by 49
“trial, reduced heart failure was confirmed in patients without diabetes [15].”
BackgroundBeta-Hydroxybutyrate, Friend or Foe for Stressed Hearts
Chu, Y., Zhang, C., & Xie, M. (2021) · Frontiers in Aging · doi:10.3389/fragi.2021.681513 · Cited by 52
“Empagliflozin significantly improves cardiovascular and renal outcomes in patients independent of baseline diabetes status in the EMOEROR-Reduced trial (Packer et al., 2020) and significantly improves cardiac function and quality of life in HFrEF patients in the EMPA-TROPISM trial (Santos-Gallego et al.”
BackgroundDrug Layering in Heart Failure
Rosano, G. M. C., Allen, L. A., Abdin, A., Lindenfeld, J. M., O’Meara, E., Lam, C. S. P., Lancellotti, P., Savarese, G., Gottlieb, S. S., Teerlink, J. R., et al. (2021) · JACC Heart Failure · doi:10.1016/j.jchf.2021.06.011 · Cited by 50
Self-citationCharaya, K. V., Shchekochikhin, D., Andreev, D. A., Dyachuk, I., Tarasenko, S., Poltavskaya, M. G., Фератовна, М. Д., Bogdanova, A. A., Ananicheva, N., & Kuzub, А. A. (2022) · Open Heart · doi:10.1136/openhrt-2021-001936 · Cited by 51
Kim, N. H., & Kim, N. H. (2022) · Diabetes & Metabolism Journal · doi:10.4093/dmj.2022.0209 · Cited by 53
“Third, it has been demonstrated that SGLT2 inhibitors have beneficial effects not only on renal outcomes but also on heart failure outcomes [39-41].”
BackgroundMustapić, I., Baković, D., Grabovac, Z. S., & Borovac, J. A. (2022) · Journal of Clinical Medicine · doi:10.3390/jcm12010042 · Cited by 50
Bidulka, P., Lugo-Palacios, D. G., Carroll, O., O’Neill, S., Adler, A., Basu, A., Silverwood, R. J., Bartlett, J. W., Nitsch, D., Charlton, P., et al. (2024) · BMJ · doi:10.1136/bmj-2023-077097 · Cited by 52
“10 12 13 16-24 Of the randomised controlled trials with an active comparator, some compared DPP-4 inhibitors with sulfonylureas 27-30 or compared SGLT-2 inhibitors with sulfonylureas, 31 but none compared all three drug classes.”
BackgroundLiu, Y., Xu, J., Wu, M., Xu, B., & Kang, L. (2021) · Lipids in Health and Disease · doi:10.1186/s12944-021-01430-y · Cited by 49
“As an antidiabetic drug, SGLT2i has been confirmed to decrease the risk of cardiovascular death or hospitalization for heart failure, regardless of the presence or absence of diabetes [42].”
BackgroundAguilar-Gallardo, J. S., Correa, A. A., & Contreras, J. (2021) · European Heart Journal - Cardiovascular Pharmacotherapy · doi:10.1093/ehjcvp/pvab056 · Cited by 51
Sangha, V., Lipska, K. J., Lin, Z., Inzucchi, S. E., McGuire, D. K., Krumholz, H. M., & Khera, R. (2021) · Circulation Cardiovascular Quality and Outcomes · doi:10.1161/circoutcomes.121.008381 · Cited by 48
Giugliano, D., Longo, M., Scappaticcio, L., Caruso, P., & Esposito, K. (2021) · Cardiovascular Diabetology · doi:10.1186/s12933-021-01213-w · Cited by 48
“2 months), the EMPEROR-Reduced trial [38] with empagliflozin (3730 patients with or without T2D and with HF randomized to empagliflozin or placebo and followed for a median of 16 months), the SCORED trial [34] with sotagliflozin (10 584 patients with T2D and DKD randomized to sotagliflozin or placebo and followed for…”
MethodSeidu, S., Cos, X., Brunton, S., Harris, S. B., Jansson, S. P. O., Mata‐Cases, M., Neijens, A. M. J., Topsever, P., & Khunti, K. (2022) · Primary care diabetes · doi:10.1016/j.pcd.2022.02.002 · Cited by 60
A multi-variate heart disease optimization and recognition framework
Balaha, H. M., Shaban, A. O., El-Gendy, E. M., & Saafan, M. M. (2022) · Neural Computing and Applications · doi:10.1007/s00521-022-07241-1 · Cited by 49
“heart disease, the heart fails to do its normal function by supplying blood to other body parts because of the blockage of coronary arteries that are responsible for supplying blood to the heart [8].”
BackgroundLi, X., Flynn, E. R., do Carmo, J. M., Wang, Z., da Silva, A. A., Mouton, A. J., Omoto, A. C. M., Hall, M. E., & Hall, J. E. (2022) · Frontiers in Cardiovascular Medicine · doi:10.3389/fcvm.2022.859253 · Cited by 48
Fawzy, A. M., Rivera‐Caravaca, J. M., Underhill, P., Fauchier, L., & Lip, G. Y. H. (2022) · Diabetes Obesity and Metabolism · doi:10.1111/dom.14854 · Cited by 48
“Subsequent studies have reflected similar findings for heart failure outcomes, with conflicting results for some of the other outcomes.(6,7)”
ResultEscobar, C., Palacios, B., Varela, L. F., Gutiérrez, M., Duong, M., Chen, H., Justo, N., Cid-Ruzafa, J., Hernández, I., Hunt, P. R., et al. (2022) · Journal of Clinical Medicine · doi:10.3390/jcm11175199 · Cited by 50
Evans, M., Morgan, A. R., Davies, S., Beba, H., & Strain, W. D. (2022) · Age and Ageing · doi:10.1093/ageing/afac201 · Cited by 50
Treatment of type 2 diabetes patients with heart conditions
Aktaş, G., Tel, B. M. A., Tel, M. R., & Balci, B. (2023) · Expert Review of Endocrinology & Metabolism · doi:10.1080/17446651.2023.2204941 · Cited by 49
“Large clinical trials, including Emperor Reduced [93] and Dapa-HF [94], reported that the”
MethodOzaki, A. F., Ko, D. T., Chong, A. S., Fang, J., Atzema, C. L., Austin, P. C., Stukel, T. A., Tu, K., Udell, J. A., Naimark, D. M. J., et al. (2023) · CMAJ Open · doi:10.9778/cmajo.20220039 · Cited by 49
Lin, J., Pearson, S.-A., Greenfield, J. R., Park, K. H., Havard, A., Brieger, D., Day, R. O., Falster, M. O., & de Oliveira Costa, J. (2023) · European Journal of Clinical Pharmacology · doi:10.1007/s00228-023-03539-8 · Cited by 48
“Encouragingly, we found that medicines with higher cardiovascular benefits such as empagliflozin [29] and dulaglutide or semaglutide [30, 31] were the most commonly initiated in the subgroup of new users with evidence of cardiovascular conditions.”
BackgroundImmunomodulation and immunopharmacology in heart failure
Markousis‐Mavrogenis, G., Baumhove, L., Al‐Mubarak, A. A., Aboumsallem, J. P., Bömer, N., Voors, A. A., & van der Meer, P. (2023) · Nature Reviews Cardiology · doi:10.1038/s41569-023-00919-6 · Cited by 51
“Therapeutic options for HF have been extended beyond traditional neurohormonal modulation only in the past 3–4 years, with the advent of sodium–glucose cotransporter 2 (SGLT2) inhibitors 3,4 .”
Zile, M. R., Lindenfeld, J. M., Weaver, F. A., Zannad, F. M., Galle, E. G., Rogers, T. B., & Abraham, W. T. (2024) · European Journal of Heart Failure · doi:10.1002/ejhf.3232 · Cited by 48
Self-citationLipotoxicity as a therapeutic target in obesity and diabetic cardiomyopathy
Nakamura, M. (2024) · Journal of Pharmacy & Pharmaceutical Sciences · doi:10.3389/jpps.2024.12568 · Cited by 53
Martínez, J. J. G., Górriz, J. L., Cuenca, A. M. C., Conde, A. C., & Velasco, M. (2024) · Journal of Clinical Medicine · doi:10.3390/jcm13216509 · Cited by 54
Mroueh, A., Algara‐Suárez, P., Fakih, W., Gong, D.-S., Matsushita, K., Park, S., Amissi, S., Auger, C., Kauffenstein, G., Meyer, N., et al. (2024) · Cardiovascular Research · doi:10.1093/cvr/cvae257 · Cited by 49
Silverii, G. A., Monami, M., & Mannucci, E. (2020) · Diabetes Obesity and Metabolism · doi:10.1111/dom.14286 · Cited by 51
Aberle, J., Menzen, M., Schmid, S. M., Terkamp, C., Jaeckel, E., Rohwedder, K., Scheerer, M. F., Xu, J. L., Tang, W., & Birkenfeld, A. L. (2020) · Scientific Reports · doi:10.1038/s41598-020-78734-z · Cited by 48
Yan, Y., Liu, B., Du, J. C., Wang, J., Jing, X., Liu, Y., Deng, S., Du, J., & She, Q. (2021) · ESC Heart Failure · doi:10.1002/ehf2.13313 · Cited by 48
“In order to explore whether SGLT2i had similar effects on patients with HFrEF regardless of DM status, the DAPA-HF and EMPEROR-HF trials were conducted.(7,14) Their results showed that both dapagliflozin and empagliflozin had a lower rate of composite for cardiovascular death or hospitalization for heart failure and h…”
BackgroundButt, J. H., Docherty, K. F., Petrie, M. C., Schou, M., Kosiborod, M., O’Meara, E., Katova, T., Ljungman, C. E. A., Díez, M., Ogunniyi, M. O., et al. (2021) · JAMA Cardiology · doi:10.1001/jamacardio.2021.0379 · Cited by 57
Self-citationXie, Y., Bowe, B. C., Gibson, A. K., McGill, J. B., Maddukuri, G. S., & Al‐Aly, Z. (2021) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2021.2488 · Cited by 49
Heart failure in adults with congenital heart disease
Brida, M., Lovrić, D., Griselli, M., Gil, F., & Gatzoulis, M. Α. (2022) · International Journal of Cardiology · doi:10.1016/j.ijcard.2022.03.018 · Cited by 49
Diabetes, Antidiabetic Medications and Cancer Risk in Type 2 Diabetes: Focus on SGLT-2 Inhibitors
Dąbrowski, M. (2021) · International Journal of Molecular Sciences · doi:10.3390/ijms22041680 · Cited by 50
Nakao, M., Shimizu, I., Katsuumi, G., Yoshida, Y., Suda, M., Hayashi, Y., Ikegami, R., Hsiao, Y., Okuda, S., Soga, T., et al. (2021) · Scientific Reports · doi:10.1038/s41598-021-97787-2 · Cited by 48
Li, M., Yi, T., Fan, F., Qiu, L., Wang, Z., Weng, H., Ma, W., Zhang, Y., & Huo, Y. (2022) · Cardiovascular Diabetology · doi:10.1186/s12933-022-01574-w · Cited by 48
“The DAPA-HF study showed that dapagliflozin can significantly decrease SBP [3] whereas the EMPEROR-Reduced trial did not find a statistically significant reduction [4].”
BackgroundMethodInfluentialSex and Gender Bias as a Mechanistic Determinant of Cardiovascular Disease Outcomes
Kim, I., Field, T. S., Wan, D., Humphries, K. H., & Sedlak, T. (2022) · Canadian Journal of Cardiology · doi:10.1016/j.cjca.2022.09.009 · Cited by 48
Mori, Y., Duru, O. K., Tuttle, K. R., Fukuma, S., Taura, D., Harada, N., Inagaki, N., & Inoue, K. (2022) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/clinem/dgac591 · Cited by 48
Declining Risk of Sudden Cardiac Death in Heart Failure: Fact or Myth?
Leyva, F., Israel, C. W., & Singh, J. P. (2023) · Circulation · doi:10.1161/circulationaha.122.062159 · Cited by 47
Circulating ketone bodies and cardiovascular outcomes: the MESA study
Shemesh, E., Chevli, P. A., Islam, T., German, C. A., Otvos, J. D., Yeboah, J., Rodríguez, F., deFilippi, C. R., Lima, J. A. C., Blaha, M. J., et al. (2023) · European Heart Journal · doi:10.1093/eurheartj/ehad087 · Cited by 47
Ghosh, N., Chacko, L., Bhattacharya, H., Vallamkondu, J., Nag, S., Dey, A., Karmakar, T., Reddy, P. H., Kandimalla, R. J. L., & Dewanjee, S. (2023) · Biomedicines · doi:10.3390/biomedicines11041126 · Cited by 47
Heart Failure in Patients with Chronic Kidney Disease
Xanthopoulos, A. V., Papamichail, A., Briasoulis, Α., Loritis, K., Bourazana, A., Magouliotis, D. E., Sarafidis, P. A., Stefanidis, I., Skoularigis, J. S., & Triposkiadis, F. K. (2023) · Journal of Clinical Medicine · doi:10.3390/jcm12186105 · Cited by 56
“There is compelling evidence that SGLT-2i also improve outcomes in HF as reported by several trials, including the Dapagliflozin and Prevention of Adverse Outcomes in Heart Failure (DAPA-HF) [92], Empagliflozin Outcome Trial in Patients with Chronic Heart Failure and a Reduced Ejection Fraction (EMPEROR-Reduced) [93],…”
JCS/JHFS 2025 Guideline on Diagnosis and Treatment of Heart Failure
Kitai, T., Kohsaka, S., Kato, T., Kato, E. T., Sato, K., TERAMOTO, K., Yaku, H., Akiyama, E., Ando, M., Izumi, C., et al. (2025) · Journal of Cardiac Failure · doi:10.1016/j.cardfail.2025.02.014 · Cited by 58
Self-citationEuglycemic Diabetic Ketoacidosis
Plewa, M. C., Bryant, M. G., & King-Thiele, R. (2021) · StatPearls · Cited by 47
Sayour, A. A., Oláh, A., Ruppert, M., Barta, B. A., Horvath, E. M., Benke, K., Pólos, M., Hartyánszky, I. L., Merkely, B. P., & Radovits, T. (2020) · Cardiovascular Diabetology · doi:10.1186/s12933-020-01141-1 · Cited by 46
Self-citationHulot, J., Trochu, J., Donal, E., Galinier, M., Logeart, D., de Groote, P., & Juillière, Y. (2021) · Expert Opinion on Pharmacotherapy · doi:10.1080/14656566.2021.1937121 · Cited by 49
McClung, J. A., Levy, L., Garcia, V. G., Stec, D. E., Peterson, S. J., & Abraham, N. G. (2021) · Pharmacology & Therapeutics · doi:10.1016/j.pharmthera.2021.107975 · Cited by 48
“Recently, SGLT2 inhibitors have demonstrated efficacy in enhancing LV function in patients with heart failure with and without diabetes (McMurray et al., 2019; Packer et al., 2020).”
BackgroundLévy, S., Steinbeck, G., Santini, L., Näbauer, M., Penela, D., Kantharia, B. K., Saksena, S. V., & Cappato, R. (2022) · Journal of Interventional Cardiac Electrophysiology · doi:10.1007/s10840-022-01195-z · Cited by 50
“In 2020, empagliflozin was found to have the same benefits regardless of the presence or absence of diabetes and that it reduces the estimated annual rate of decline in the glomerular function in the empagliflozin group [218].”
BackgroundZannad, F. M., Ferreira, J. P., Gregson, J., Kraus, B. J., Mattheus, M., Hauske, S. J., Butler, J., Filippatos, G. S., Wanner, C., Anker, S. D., et al. (2022) · European Journal of Heart Failure · doi:10.1002/ejhf.2578 · Cited by 47
Self-citationXie, Y., Bowe, B. C., Gibson, A. K., McGill, J. B., Maddukuri, G. S., & Al‐Aly, Z. (2021) · Journal of the American Heart Association · doi:10.1161/jaha.120.020237 · Cited by 47
Left Ventricular Reverse Remodelling and Its Predictors in Non-Ischaemic Cardiomyopathy
Hnát, T., Veselka, J., & Honěk, J. (2022) · ESC Heart Failure · doi:10.1002/ehf2.13939 · Cited by 45
Unequitable Heart Failure Therapy for Black, Hispanic and American-Indian Patients
Ilonze, O. J., Free, K., & Breathett, K. K. (2022) · Cardiac failure review · doi:10.15420/cfr.2022.02 · Cited by 46
Pruett, J. E., Everman, S. J., Hoang, N., Salau, F., Taylor, L. C., Edwards, K. S., Hosler, J. P., Huffman, A. M., Romero, D. G., & Cardozo, L. L. Y. (2022) · Biology of Sex Differences · doi:10.1186/s13293-022-00455-x · Cited by 46
SGLT2 Inhibitors in Diabetic and Non-Diabetic Chronic Kidney Disease
Podestà, M. A., Sabiu, G., Galassi, A., Ciceri, P., & Cozzolino, M. G. (2023) · Biomedicines · doi:10.3390/biomedicines11020279 · Cited by 47
“Several additional randomized controlled trials were conducted to evaluate the effect of SGLT2is on cardiovascular outcomes in patients with heart failure with or without diabetes (DAPA-HF [38,39], EMPEROR-Reduced [40], EMPEROR-Preserved [41], DELIVER [42] and SOLOIST-WHF [43]).”
BackgroundMiyamoto, Y., Honda, A., Yokose, S., Nagata, M., & Miyamoto, J. (2023) · Journal of Clinical Medicine · doi:10.3390/jcm12062253 · Cited by 48
“In EMPA-REG OUTCOME, a study of empagliflozin in type 2 diabetic patients with a history of cardiovascular disease, empagliflozin showed renal protection when observed over time, although a temporary decrease in the renal function was observed [7].”
MethodEfficacy of Empagliflozin in Patients With Heart Failure Across Kidney Risk Categories
Butler, J., Packer, M., Siddiqi, T. J., Böhm, M., Brueckmann, M., Januzzi, J. L., Verma, S., Gergei, I., Iwata, T., Wanner, C., et al. (2023) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2023.03.390 · Cited by 47
Self-citationDimitriadis, K. S., Adamopoulou, E., Pyrpyris, N., Sakalidis, A., Leontsinis, I., Manta, E., Mantzouranis, E., Beneki, E., Σουλαϊδόπουλος, Σ., Konstantinidis, D., et al. (2023) · European Heart Journal - Cardiovascular Pharmacotherapy · doi:10.1093/ehjcvp/pvad053 · Cited by 50
SGLT2i effect on atrial fibrillation: A network meta‐analysis of randomized controlled trials
Mariani, M. V., Manzi, G., Pierucci, N., Laviola, D., Piro, A., D’Amato, A., Filomena, D., Matteucci, A., Severino, P., Miraldi, F., et al. (2024) · Journal of Cardiovascular Electrophysiology · doi:10.1111/jce.16344 · Cited by 48
Cardiometabolic and renal benefits of sodium–glucose cotransporter 2 inhibitors
Lee, Y., Lim, S. K., & Davies, M. J. (2025) · Nature Reviews Endocrinology · doi:10.1038/s41574-025-01170-4 · Cited by 56
“The utility of SGLT2 inhibitors extends across the spectrum of heart failure, as evidenced in the EMPEROR-REDUCED (empagliflozin) 8 , EMPEROR-PRESERVED (empagliflozin) 9 , SOLOIST-WHF (sotagliflo-zin) 10 , DAPA-HF (dapagliflozin) 11 and DELIVER (dapagliflozin) 12 trials, in which heart…”
Becher, P. M., Schrage, B., Ferrannini, G., Benson, L., Butler, J., Carrero, J. J., Cosentino, F., Dahlström, U., Mellbin, L., Rosano, G. M. C., et al. (2021) · European Journal of Heart Failure · doi:10.1002/ejhf.2131 · Cited by 46
Self-citationButt, J. H., Nicolau, J. C., Verma, S., Docherty, K. F., Petrie, M. C., Inzucchi, S. E., Schou, M., Kosiborod, M., Langkilde, A. M., Martínez, F. A., et al. (2021) · European Journal of Heart Failure · doi:10.1002/ejhf.2124 · Cited by 51
Self-citationErtugliflozin and Slope of Chronic eGFR
Cherney, D. Z. I., Cosentino, F., Dagogo-Jack, S. E., McGuire, D. K., Pratley, R. E., Frederich, R. C., Maldonado, M., Liu, C., Liu, J., Pong, A., et al. (2021) · Clinical Journal of the American Society of Nephrology · doi:10.2215/cjn.01130121 · Cited by 47
“73 m(2) per year over a median follow-up of 16 months (11).”
BackgroundMethodSánchez, J. J. G., Thompson, J. C., Scott, D. A., Evans, R., Rao, N., Sörstadius, E., James, G., NOLAN, S. T., Wittbrodt, E. T., Sultan, A. A., et al. (2021) · Advances in Therapy · doi:10.1007/s12325-021-02006-z · Cited by 53
Tuttle, K. R., Levin, A., Nangaku, M., Kadowaki, T., Agarwal, R., Hauske, S. J., Elsäßer, A., Ritter, I., Steubl, D., Wanner, C., et al. (2022) · Diabetes Care · doi:10.2337/dc21-2034 · Cited by 48
“73 m(2), irrespective of diabetes status (10).”
Self-citationBarbarawi, M., Al‐Abdouh, A., Barbarawi, O., Lakshman, H. G., kasasbeh, M. A., & Chen, K. (2021) · Heart Failure Reviews · doi:10.1007/s10741-021-10083-z · Cited by 46
Metadata
- Authors
- Packer, M., Anker, S. D., Butler, J., Filippatos, G., Pocock, S. J., Carson, P., Januzzi, J., Verma, S., Tsutsui, H., Brueckmann, M., Jamal, W., Kimura, K., Schnee, J., Zeller, C., Cotton, D., Bocchi, E., Böhm, M., Choi, D.-J., Chopra, V., Chuquiure, E., Giannetti, N., Janssens, S., Zhang, J., Gonzalez Juanatey, J. R., Kaul, S., Brunner-La Rocca, H.-P., Merkely, B., Nicholls, S. J., Perrone, S., Pina, I., Ponikowski, P., Sattar, N., Senni, M., Seronde, M.-F., Spinar, J., Squire, I., Taddei, S., Wanner, C., & Zannad, F.
- Affiliations
- University of Leicester (GB)
- Harvard University (US)
- St. Michael's Hospital (CA)
- Kyushu University (JP)
- Boehringer Ingelheim (Germany) (DE)
- Seoul National University (KR)
- From Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas (M.P.); Imperial College (M.P.) and the Department of Medical Statistics, London School of Hygiene and Tropical Medicine (S.J.P.), London, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow (N.S.), and the Department of Cardiovascular Sciences, University of Leicester and National Institute for Health Research Biomedical Research Centre, Glenfield Hospital, Leicester (I.S.) — all in the United...
- Cedars-Sinai Medical Center (US)
- University of Pisa (IT)
- ORCID
- Packer, Milton
- Anker, Stefan D.
- Butler, Javed
- Filippatos, Gerasimos
- Pocock, Stuart J.
- Januzzi, James
- Verma, Subodh
- Tsutsui, Hiroyuki
- Brueckmann, Martina
- Jamal, Waheed
- Kimura, Karen
- Schnee, Janet
- Zeller, Cordula
- Cotton, Daniel
- Bocchi, Edimar
- Böhm, Michael
- Choi, Dong-Ju
- Chopra, Vijay
- Giannetti, Nadia
- Janssens, Stefan
- Zhang, Jian
- Kaul, Sanjay
- Nicholls, Stephen J.
- Perrone, Sergio
- Ponikowski, Piotr
- Sattar, Naveed
- Senni, Michele
- Seronde, Marie-France
- Squire, Iain
- Taddei, Stefano
- Wanner, Christoph
- Zannad, Faiez
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2020-10-08
- Volume
- 383
- Issue
- 15
- Pages
- 1413-1424
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- OpenAlex
- W3081830235
- Semantic Scholar
- 9f762448aff37cda38166e57ac40bc13f0005f51
- Cited by
- 5,206
- References
- 10
- Citations by year
- 2026: 638 · 2025: 757 · 2024: 820 · 2023: 965 · 2022: 936 · 2021: 910 · 2020: 163
- FWCI
- 459.86
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- ENLIGHTEN (Jurnal Bimbingan dan Konseling Islam) (acceptedVersion, cc-by-sa)
- HAL (submittedVersion, other-oa)
- CINECA IRIS Institutial research information system (University of Pisa) (submittedVersion, other-oa)
- Radboud Repository (Radboud University) (submittedVersion)
- BOA (University of Milano-Bicocca) (submittedVersion)
- Research Publications (Maastricht University) (submittedVersion, other-oa)
- Figshare (submittedVersion, cc-by)
- IRIS Research product catalog (Sapienza University of Rome) (submittedVersion)
- Lirias (submittedVersion)
- Radboud Repository (Radboud University) (submittedVersion, other-oa)
- Funders
- Boehringer Ingelheim
- Eli Lilly
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
- Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Keywords
- empagliflozin, SGLT2 inhibitors, heart failure with reduced ejection fraction, cardiovascular mortality, hospitalization for worsening heart failure, renal outcomes, estimated glomerular filtration rate decline, genital tract infection, diabetes status, EMPEROR-Reduced trial
- MeSH terms
- Sodium-Glucose Transporter 2 Inhibitors, Aged, Benzhydryl Compounds, Cardiovascular Diseases, Diabetes Mellitus, Type 2, Double-Blind Method, Female, Glomerular Filtration Rate, Glucosides, Heart Failure, Hospitalization, Humans, Male, Middle Aged, Stroke Volume, Proportional Hazards Models, Disease Progression, Renal Insufficiency, Chronic
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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