Empagliflozin reduces cardiovascular mortality in type 2 diabetes patients with established cardiovascular disease. Beyond glycaemic lowering, its major cardiovascular protective mechanism involves:

• A Direct SGLT2 receptor blockade in the myocardium improving energy substrate utilisation
• B GLP-1 receptor agonism reducing inflammation in atherosclerotic plaques
• C Reduction of preload and afterload through osmotic diuresis and natriuresis, mimicking haemodynamic effects similar to loop diuretics ✓
• D Inhibition of aldosterone secretion from the adrenal cortex

Explanation

SGLT2 inhibitors produce significant glucosuria and natriuresis, reducing plasma volume, preload and afterload on the failing heart — an effect analogous to loop diuretics. They also reduce body weight, visceral adiposity, and blood pressure. Additionally, ketone bodies generated during SGLT2 inhibition may serve as alternative cardiac fuel. These haemodynamic and metabolic effects collectively reduce hospitalisation for heart failure and cardiovascular death.

Reference: KD Tripathi, Essentials of Medical Pharmacology, 8th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.