How Does Empagliflozin Improve Arterial Stiffness In Patients With Type 2 Diabetes Mellitus? Sub Analysis Of A Clinical Trial

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How Does Empagliflozin Improve Arterial Stiffness In Patients With Type 2 Diabetes Mellitus Sub Analysis Of A Clinical Trial

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PROJECT TOPIC AND MATERIAL ON HOW DOES EMPAGLIFLOZIN IMPROVE ARTERIAL STIFFNESS IN PATIENTS WITH TYPE 2 DIABETES MELLITUS? SUB ANALYSIS OF A CLINICAL TRIAL

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  • Name: How Does Empagliflozin Improve Arterial Stiffness In Patients With Type 2 Diabetes Mellitus? Sub Analysis Of A Clinical Trial
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Introduction

Treatment of type 2 diabetes should aim at improving vascular structure and function in the micro- and macrocirculation besides metabolic control [1]. Arterial stiffness, a key parameter of vascular changes, is characterized by an increased pulse wave velocity along the arterial tree of both the forward and backward (reflected) pulse wave leading to increased central systolic blood pressure and elevated central pulse pressure [2, 3]. Central systolic blood pressure is the integral of various components of arterial stiffness, an important surrogate parameter of afterload, and strongly linked to future cardiovascular outcome [4, 5]. Likewise, central pulse pressure has been shown to be superior in the prediction of cardiovascular events compared to measurements of pulse pressure at the brachial level, and there is evidence for an association between both forward and backward wave amplitudes and increased risk for incident cardiovascular disease and all-cause mortality [5,6,7].

In the EMPA-REG OUTCOME study (Empagliflozin Cardiovascular Outcome Event Trial in Type 2 Diabetes Mellitus Patients) treatment with the selective sodium-glucose cotransporter 2 inhibitor (SGLT2-inhibitor) empagliflozin reduced the primary combined cardiovascular end point as well as secondary end points of hospitalization due to heart failure, cardiovascular morbidity, total mortality and renal end points [8]. The underlying pathophysiologic mechanisms are currently under intensive discussion, but the crucial question about the pivotal mechanism causing the reduced cardiovascular death rate and total mortality still remains to be elucidated. Interestingly, the benefits observed in the EMPA-REG OUTCOME study were documented in a population in whom cardiovascular risk factors, including blood pressure and dyslipidemia were well treated with the use of renin–angiotensin–aldosterone system inhibitors, statins and acetylsalicylic acid. The authors of the EMPA-REG OUTCOME study mention changes in arterial stiffness among others as possible mechanisms [8]. Most recently we have shown that empagliflozin improves arterial stiffness in a double blind, placebo controlled, crossover clinical trial including 71 patients with type 2 diabetes mellitus [9]. The aim of the current analysis is to identify potential determinants for the improvement of arterial stiffness observed during empagliflozin therapy.

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