Empagliflozin reduces cardiovascular events, mortality and renal events in participants with type 2 diabetes after coronary artery bypass graft surgery: Subanalysis of the EMPA-REG OUTCOME randomised trial

Diabetologia - Clinical and Experimental Diabetes and Metabolism Jul 11, 2018

Verma S, et al. - The effects of the sodium glucose cotransporter 2 inhibitor empagliflozin on cardiovascular events and mortality in participants with type 2 diabetes and a self-reported history of coronary artery bypass graft (CABG) surgery were determined in this post hoc analysis of the EMPA-REG OUTCOME trial. Researchers reported that treatment with empagliflozin was correlated with dramatic reductions in cardiovascular and all-cause mortality, hospitalization for heart failure, and incident or worsening nephropathy in these patients. In individuals with type 2 diabetes, these findings have important implications for the secondary prevention of cardiovascular events after CABG.


  • The EMPA-REG OUTCOME trial was a randomized, double-blind, placebo-controlled trial.
  • For the purpose of this investigation, patients with type 2 diabetes and established cardiovascular disease were randomly allocated 1:1:1 to receive placebo, empagliflozin 10 mg or empagliflozin 25 mg, once daily, in addition to standard of care.
  • Researchers evaluated cardiovascular death, all-cause mortality, hospitalization for heart failure, and incident or worsening nephropathy (progression to macroalbuminuria, doubling of serum creatinine, initiation of renal replacement therapy or death due to renal disease) in subgroups by self-reported history of CABG (yes/no) at baseline.
  • Using a Cox proportional hazards model, differences in risk between empagliflozin and placebo were evaluated.


  • The study results showed that 25% (1,175/4,687) of patients who received empagliflozin and 24% (563/2,333) of patients who received placebo had a history of CABG surgery at baseline.
  • It was observed that HRs (95% CI) with empagliflozin vs placebo were 0.52 (0.32, 0.84) for cardiovascular mortality, 0.57 (0.39, 0.83) for all-cause mortality, 0.50 (0.32, 0.77) for hospitalization for heart failure and 0.65 (0.50, 0.84) for incident or worsening nephropathy in members with a history of CABG surgery.
  • According to the findings, results were consistent between participants with and without a history of CABG surgery (p > 0.05 for treatment by subgroup interactions).
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