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Empagliflozin reduces the risk of mortality and hospitalization for heart failure across Thrombolysis In Myocardial Infarction Risk Score for Heart Failure in Diabetes categories: Post hoc analysis of the EMPA‐REG OUTCOME trial
Author(s) -
Verma Subodh,
Sharma Abhinav,
Zinman Bernard,
Ofstad Anne Pernille,
Fitchett David,
Brueckmann Martina,
Wanner Christoph,
Zwiener Isabella,
George Jyothis T.,
Inzucchi Silvio E.,
Butler Javed,
Mazer C. David
Publication year - 2020
Publication title -
diabetes, obesity and metabolism
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.445
H-Index - 128
eISSN - 1463-1326
pISSN - 1462-8902
DOI - 10.1111/dom.14015
Subject(s) - empagliflozin , medicine , myocardial infarction , post hoc analysis , placebo , diabetes mellitus , heart failure , cardiology , type 2 diabetes , hazard ratio , confidence interval , endocrinology , alternative medicine , pathology
Abstract Aim To investigate the association of the Thrombolysis In Myocardial Infarction (TIMI) Risk Score for Heart Failure in Diabetes (TRS‐HF DM ) with mortality using data from the EMPA‐REG OUTCOME trial. Materials and Methods In EMPA‐REG OUTCOME, patients with type 2 diabetes and atherosclerotic cardiovascular (CV) disease (N = 7020) received the sodium‐glucose co‐transporter‐2 inhibitor, empagliflozin, 10 or 25 mg or placebo. Post hoc , patients were stratified into risk categories (low‐intermediate, high, very‐high risk scores) using baseline TRS‐HF DM . Cox regression analyses evaluated the association of TRS‐HF DM categories with all‐cause mortality (ACM), CV death, hospitalization for heart failure (HHF) and CV death (excluding fatal stroke) or HHF, and whether empagliflozin reduced the risk of CV outcomes across these risk categories. Results In placebo patients, increasing risk category was associated with a higher risk of ACM, CV death, and HHF. Empagliflozin reduced the risk of ACM (low‐intermediate HR 0.68 [95% CI 0.48, 0.97] and very‐high 0.69 [0.52, 0.91]), CV death (0.75 [0.48, 1.18] and 0.56 [0.41, 0.78]), HHF (0.53 [0.28, 1.01] and 0.67 [0.48, 0.96]), and CV death or HHF (0.69 [0.46, 1.03]) and (0.64 [0.49, 0.82]) across all risk categories versus placebo. Higher absolute risk reductions (ARRs) were observed for CV death in the very‐high versus low‐intermediate category ( P = 0.01). Conclusions Applied to EMPA‐REG OUTCOME, higher TRS‐HF DM was associated with increased HHF and mortality risk. Empagliflozin reduced CV outcomes across TRS‐HF DM categories. Higher ARRs were associated with higher risk scores.