The EMPA-REG OUTCOME trial demonstrated that empagliflozin significantly reduced cardiovascular death in type 2 diabetics. The primary mechanism responsible for this cardiorenal benefit is BEST described as:

• A SGLT2 inhibition causing osmotic diuresis and reduced preload/afterload ✓
• B Reduction in HbA1c by 1.5%
• C Inhibition of RAAS at the proximal tubule
• D Direct anti-inflammatory effect on coronary plaque

Explanation

The cardiorenal benefit of SGLT2 inhibitors in EMPA-REG OUTCOME is attributed to haemodynamic effects: glycosuric diuresis reduces plasma volume, preload, and afterload, reducing cardiac work. This benefit appeared within weeks, too quickly for glucose-lowering alone to explain it. Additional mechanisms include ketone body utilisation by the heart, reduced epicardial fat, and tubuloglomerular feedback restoring intraglomerular pressure. RAAS inhibition is not a direct mechanism of SGLT2 inhibitors.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.