Jardiance is NOT Contraindicated in Peripheral Vascular Disease
Jardiance (empagliflozin) is not contraindicated in patients with peripheral vascular disease (PVD). This appears to be a misconception, as there is no absolute contraindication for empagliflozin use in PVD patients based on current evidence and guidelines.
Key Evidence Points
SGLT-2 Inhibitors and Peripheral Artery Disease Risk
Empagliflozin specifically has not been shown to increase the risk of peripheral artery disease or lower limb amputations 1. A 2019 meta-analysis found that while canagliflozin was associated with increased peripheral artery disease risk (MH-OR: 1.26 [1.04,1.52]), there is "no reason to believe that empagliflozin or dapagliflozin increase the risk of either peripheral artery disease or lower limb amputations" 1.
The cardiovascular safety profile of empagliflozin in patients with established cardiovascular disease (including polyvascular disease) is favorable 2. In the EMPA-REG OUTCOME trial, empagliflozin consistently reduced the risk of heart failure hospitalization, cardiovascular death, and major adverse cardiovascular events across all subgroups, including those with polyvascular disease 2.
Important Distinction: Canagliflozin vs. Empagliflozin
- Canagliflozin carries a specific amputation risk warning, but this does not extend to empagliflozin 1. The class effect should not be assumed across all SGLT-2 inhibitors, as the amputation signal was specific to canagliflozin in clinical trials 1, 3.
Clinical Management in PVD Patients
Standard PVD Care Remains Essential
Meticulous foot care is mandatory for all diabetic patients with PVD, including appropriate footwear, daily foot inspection, skin cleansing, topical moisturizing creams, and urgent attention to any skin lesions or ulcerations 4.
Glycemic control targeting HbA1c <7% is recommended to reduce microvascular complications 4.
Cardiovascular Risk Reduction
- Empagliflozin has demonstrated cardiovascular benefits in high-risk patients, including those with polyvascular disease, reducing heart failure hospitalization and cardiovascular death 3, 2.
Common Pitfall to Avoid
Do not confuse the canagliflozin amputation warning with a class-wide contraindication for all SGLT-2 inhibitors in PVD. Each agent in this class has distinct safety profiles regarding peripheral vascular complications 1. Empagliflozin lacks the amputation signal seen with canagliflozin and can be safely used in PVD patients when appropriate diabetes management and foot care protocols are followed 1, 2.