From the Guidelines
Empagliflozin is generally preferred over ertugliflozin for heart attack prevention in people with established cardiovascular disease or multiple risk factors. Both medications belong to the SGLT2 inhibitor class, but empagliflozin has stronger evidence supporting its cardiovascular benefits, as demonstrated in the EMPA-REG OUTCOME trial, which showed a 14% reduction in major adverse cardiovascular events and a 38% reduction in cardiovascular death compared to placebo 1. The most recent guidelines, such as those published in 2024, continue to support the use of SGLT2 inhibitors, including empagliflozin, for the prevention of heart failure hospitalizations and cardiovascular death in people with type 2 diabetes and established cardiovascular disease or multiple risk factors 1.
Some key points to consider when prescribing empagliflozin include:
- Typical dosing is 10mg or 25mg once daily, with the 25mg dose showing better cardiovascular outcomes in clinical trials
- Patients should take the medication in the morning with or without food and maintain adequate hydration to prevent side effects like urinary tract infections or dehydration
- Empagliflozin has additional benefits, including blood pressure reduction, weight loss, and improved heart failure outcomes, which likely contribute to its cardioprotective properties beyond glucose control
- The medication should be used in conjunction with other evidence-based treatments for cardiovascular disease, such as ACE inhibitors or ARBs, and beta-blockers, as recommended by current treatment guidelines 1.
Overall, the evidence suggests that empagliflozin is a preferred choice for heart attack prevention in people with established cardiovascular disease or multiple risk factors, due to its strong cardiovascular benefits and additional effects on blood pressure, weight, and heart failure outcomes.
From the Research
Empagliflozin vs Ertugliflozin for Heart Attack Prevention
- There are no direct studies comparing empagliflozin to ertugliflozin for heart attack prevention in people 2, 3, 4, 5, 6.
- However, studies have shown that empagliflozin is effective in reducing the risk of cardiovascular events, including heart attacks, in patients with type 2 diabetes 2, 4, 5, 6.
- A study published in the Journal of the American Medical Association (JAMA) found that empagliflozin was associated with a lower risk of major adverse cardiovascular events (MACE) compared to liraglutide and sitagliptin in older adults with type 2 diabetes 2.
- Another study published in the New England Journal of Medicine found that empagliflozin did not significantly reduce the risk of hospitalization for heart failure or death from any cause in patients who had been hospitalized for acute myocardial infarction 4.
- A network meta-analysis published in the Journal of Clinical Pharmacy and Therapeutics found that empagliflozin at a dose of 25 mg was the most effective dose in reducing HbA1c and fasting plasma glucose in patients with type 2 diabetes 3.
- A review of empagliflozin published in the journal Drugs found that it is a valuable treatment option for the management of type 2 diabetes, with demonstrable cardioprotective benefits 5.
- A cost-effectiveness analysis published in BMJ Open Diabetes Research & Care found that empagliflozin was cost-effective compared to canagliflozin, dapagliflozin, and standard of care in patients with type 2 diabetes and established cardiovascular disease 6.