Benefits of Jardiance (Empagliflozin) for Atherosclerosis
Empagliflozin significantly reduces the risk of major adverse cardiovascular events by 14% in patients with atherosclerosis, with a particularly strong 38% reduction in cardiovascular death, making it a valuable medication for patients with type 2 diabetes and established atherosclerotic cardiovascular disease. 1, 2
Cardiovascular Benefits
Empagliflozin reduces the primary composite endpoint of cardiovascular death, myocardial infarction (MI), or stroke by 14% (HR 0.86; 95% CI 0.74-0.99) in patients with type 2 diabetes and established cardiovascular disease 1
The most significant benefit is a 38% reduction in cardiovascular death (HR 0.62; 95% CI 0.49-0.77), which is a major driver of the overall cardiovascular benefit 1, 2
Empagliflozin reduces hospitalization for heart failure by 35% (HR 0.65; 95% CI 0.50-0.85), providing additional cardiovascular protection beyond atherosclerotic events 1
The FDA has specifically approved empagliflozin to reduce the risk of cardiovascular death in adults with type 2 diabetes and established cardiovascular disease 1, 2
Mechanisms of Action Against Atherosclerosis
Empagliflozin reduces inflammation, a key driver of atherosclerosis, by decreasing levels of inflammatory markers such as TNF-α, IL-6, and monocyte chemoattractant protein-1 (MCP-1) 3
The medication decreases insulin resistance, which correlates significantly with reduced atherosclerotic plaque size 3
Empagliflozin inhibits the progression of atherosclerotic lesions by reducing inflammatory cell infiltration in plaques 4
The medication has been shown to decrease sympathetic nervous system activity, which contributes to its anti-atherosclerotic effects 4
Benefits Across the Cardiovascular Risk Spectrum
The cardiovascular benefits of empagliflozin are consistent across the spectrum of baseline cardiovascular risk, benefiting patients regardless of their initial risk level 5
Patients with prior myocardial infarction or stroke receive similar relative risk reductions as those without these specific prior events 5
In diabetic mouse models, empagliflozin has been shown to not only slow atherosclerosis progression but also accelerate atherosclerosis regression 6
Additional Cardiometabolic Benefits
Empagliflozin provides moderate reductions in body weight (approximately 2.1-2.5 kg) and systolic blood pressure (2.9-5.2 mmHg), which may contribute to its cardiovascular benefits 7
The medication improves lipid profiles and reduces fat accumulation in the liver, which are important factors in atherosclerosis development 3
Empagliflozin increases adiponectin levels, which has anti-inflammatory and anti-atherogenic properties 3
Important Considerations and Cautions
The risk of hypoglycemia with empagliflozin is low unless it is combined with insulin or insulin secretagogues 1
Patients should be monitored for potential side effects including genital mycotic infections and volume depletion-related events 7
Empagliflozin should be used with caution during periods of metabolic stress (illness, surgery, reduced food intake) due to the risk of euglycemic diabetic ketoacidosis 8
The medication should be temporarily discontinued 3-4 days before scheduled surgery to minimize the risk of complications 8
Patients with reduced renal function, elderly patients, and those on diuretics require careful monitoring when taking empagliflozin 8
Current Guideline Recommendations
In people with type 2 diabetes and established atherosclerotic cardiovascular disease (ASCVD), multiple ASCVD risk factors, or chronic kidney disease, an SGLT2 inhibitor with demonstrated cardiovascular benefit like empagliflozin is recommended to reduce the risk of major adverse cardiovascular events 1
Empagliflozin is particularly beneficial for patients with both atherosclerosis and heart failure risk, as it significantly reduces heart failure hospitalizations 1
The American College of Cardiology recommends that cardiovascular specialists consider SGLT2 inhibitors like empagliflozin for cardiovascular risk reduction in patients with type 2 diabetes and established ASCVD 1