The EMPA-REG OUTCOME trial demonstrated that empagliflozin reduced cardiovascular mortality in type 2 diabetics with established CVD. The PRIMARY mechanism responsible for this cardiac benefit is best explained by:

• A Reduction in HbA1c lowering atherosclerotic plaque burden
• B Direct anti-inflammatory action on coronary endothelium
• C GLP-1 receptor-mediated cardioprotection
• D Diuresis-mediated reduction in cardiac preload and afterload (haemodynamic effect) ✓

Explanation

The EMPA-REG OUTCOME trial showed a rapid (within weeks) cardiovascular mortality benefit with empagliflozin, too fast to attribute to glycaemic or atheromatous change. The dominant mechanism is haemodynamic: SGLT2 inhibitors cause osmotic-natriuretic diuresis reducing preload, afterload, and filling pressures, thus offloading a failing heart. Additional metabolic effects (ketone utilisation as cardiac fuel) contribute, but the haemodynamic hypothesis is the primary accepted explanation.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.