A 58-year-old man with type 2 diabetes is started on empagliflozin. The EMPA-REG OUTCOME trial demonstrated that this drug's cardiovascular benefit is primarily attributed to which mechanism?

• A Reduction in HbA1c leading to fewer atherosclerotic plaques
• B Osmotic diuresis and natriuresis reducing cardiac preload and afterload ✓
• C Direct anti-inflammatory effect on coronary endothelium
• D Inhibition of RAAS pathway through GLP-1 receptor activation

Explanation

Empagliflozin's cardiovascular benefit demonstrated in the EMPA-REG OUTCOME trial is largely attributed to haemodynamic effects: SGLT2 inhibition causes glycosuria with obligate osmotic diuresis and natriuresis, reducing preload and afterload on a failing heart, often described as mimicking a loop diuretic. The glycaemic benefit alone is insufficient to explain the rapid onset of benefit seen in the trial. Options A, C, and D are not the primary mechanisms established in the trial.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.