Impact of Empagliflozin on Heart Failure Risk in Overweight Patients

Overview

In a randomized, placebo-controlled trial of non-diabetic overweight patients at high risk of heart failure, empagliflozin significantly reduced estimated extracellular volume (eECV) after 180 days, indicating a reduction in fluid overload. However, empagliflozin did not significantly affect ventricular epicardial adipose tissue (EAT) mass compared to placebo.

Background

Heart failure (HF) is a major global health burden with increasing prevalence linked to aging and obesity. Obesity contributes to HF risk through mechanisms including hypervolemia and excess epicardial adipose tissue (EAT). Sodium glucose co-transporter 2 (SGLT2) inhibitors like empagliflozin have shown cardiovascular benefits in patients with type 2 diabetes and HF, including reductions in hospitalizations for HF. Whether these benefits extend to non-diabetic overweight individuals at risk of HF remains unclear, prompting investigation into empagliflozin's effects on fluid volume and cardiac fat in this population.

Data Highlights

Key Findings

• Empagliflozin treatment for 180 days significantly reduced estimated extracellular volume (eECV) compared to placebo in overweight, non-diabetic patients at high risk of HF.
• No significant difference was observed between empagliflozin and placebo in changes to ventricular epicardial adipose tissue (EAT) mass.
• The median age of participants was 68 years with a median BMI of 31.9 kg/m2, indicating an older, overweight population.
• Empagliflozin was well tolerated with few reported side effects, supporting its safety in this population.
• The reduction in eECV suggests potential for empagliflozin to alleviate fluid overload, a key contributor to HF development.

Clinical Implications

Empagliflozin may offer a preventive benefit against heart failure in overweight patients without diabetes by reducing extracellular fluid volume, potentially mitigating hypervolemia-related cardiac stress. However, its lack of effect on epicardial adipose tissue suggests that additional strategies may be needed to address cardiac fat accumulation in this population. Clinicians should consider empagliflozin as a safe option for fluid management in high-risk overweight patients.

Conclusion

In non-diabetic overweight patients at risk of heart failure, empagliflozin significantly reduces extracellular fluid volume but does not affect cardiac fat mass. These findings support empagliflozin's potential role in heart failure prevention through fluid volume modulation.

References

1. Empire Prevent Metabolic Study Group 2024 -- Impact of Empagliflozin on Heart Failure Risk in Overweight Patients