Dr. Shomali Diabetes Update: Jardiance Helps People with Heart Failure
EMPEROR studies show Jardiance is not just for diabetes
Those of you who know me or have read our diabetes books probably can see that I am big into data and science. But I don’t follow data just for the sake of the numbers. My goal is to translate the science into increased longevity and better quality of life for my patients with diabetes.
Enter Jardiance, one of the incredible diabetes drugs of the past couple of years. Jardiance, also known by its non-proprietary name of empagliflozin, belongs to the class of drugs, SGLT2 inhibitors, that forces out extra blood glucose (blood sugar) into the urine. These drugs inhibit a glucose transporter in the kidneys that would normally bring glucose back into the blood stream. People who take this medication enjoy lower blood glucose levels and also have some weight loss since they are losing sugar and calories in their urine. People who use Jardiance have less heart attacks and strokes, and are less likely to die of heart disease, the leading cause of death in people with diabetes.
The results of two Jardiance studies known as the EMPEROR studies were recently released. In the studies nearly 10,000 people with or without diabetes were treated with Jardiance, and compared to a control group who were not given Jardiance. Everyone in the study had a condition called heart failure. Heart failure means that the heart muscle in not able to pump enough blood and oxygen throughout the body. Jardiance users were significantly less likely to die of heart attacks or strokes or other cardiovascular events and were less likely to be hospitalized with heart failure.
How is heart failure diagnosed? To make the diagnosis, there is a special ultrasound test that measures how well the heart is pumping. The ultrasound shows what percentage of the blood in the heart is pumped out or “ejected” from the heart with every heartbeat. When the ejection fraction is low and the patient has symptoms such as shortness of breath and swelling of the legs, the diagnosis is easily made. However there is a second type of heart failure called heart failure with preserved ejection fraction or HFpEF for short. With this type, the ejection fraction is actually preserved and this makes it more difficult to diagnose. Risk factors for HFpEF include older age, female gender, high blood pressure, obesity, and diabetes.
The findings from the EMPEROR studies showed benefits in taking Jardiance in people with diabetes and in those without. Also, the benefits were seen in people with both kinds of heart failure.
Benefits of Jardiance for people with heart failure with preserved ejection fraction (HFpEF)
While there have been good treatments for people with heart failure with reduced ejection fraction, unfortunately there have not been very good treatments to date for HFpEF. This is why the results of the EMPEROR studies have generated so much excitement amongst cardiologists and endocrinologists. Jardiance is a potential treatment for this serious condition, whether or not the person with HFpEF has diabetes.
Always talk to your doctor about side effects of medication and whether a medication is right for you.