Add-On Empagliflozin Attenuates Adipose Tissue Inflammation, Arterial Stiffness in Patients With Diabetes: Presented at ESH

By Chris Berrie

BARCELONA, Spain -- June 13, 2018 -- Adding empagliflozin to metformin may attenuate adipose tissue inflammation and arterial stiffness to a greater extent than the addition of sitagliptin to metformin in normotensive patients with type 2 diabetes, according to a study presented here at the 28th Scientific Meeting of the European Society of Hypertension (ESH).

In the early stages of type 2 diabetes, adipose tissue inflammation can impair arterial compliance, explained Stamatis Efstathiou, MD, Hygeias Melathron Infirmary, Athens, Greece. This would potentially indicate the use of sodium glucose co-transporter-2 (SGLT-2) inhibitors, as their beneficial cardiovascular effects are known to include decreased arterial stiffness.

To investigate further, the researchers compared the impact of empagliflozin versus sitagliptin on aortic stiffness in normotensive patients with type 2 diabetes

Patients without hypertension were included in the study “in order to avoid the bias that could result from blood pressure control issues on arterial stiffness,” noted Dr. Efstathiou.

Patients with diabetes inadequately controlled with metformin monotherapy were randomised to receive oral sitagliptin 100 mg/day (n = 52) or empagliflozin 25 mg/day (n = 54) for 24 weeks. Arterial stiffness was assessed as carotid-femoral pulse wave velocity (PWV).

After 24 weeks there were significant changes for haemoglobin A1C and fasting plasma glucose with both empagliflozin (-0.72% and -25.3 mg/dl, respectively) and sitagliptin (-0.70% and -23.2 mg/dl, respectively; P< .001 for all comparisons).

Rates of hypoglycaemia were 2.1% with empagliflozin and 1.9% with sitagliptin (P = .494).

Blood pressure decreased with empagliflozin (systolic, -4.9 ± 0.9 mm Hg; diastolic, 2.4 ± 0.4 mm Hg), but not with sitagliptin (systolic, -1.3 ± 1.0 mm Hg; diastolic, 0.5 mm Hg).

Body weight decreased by 3.8 kg with empagliflozin and by 0.5 kg with sitagliptin (P< .001 for between-group difference).

PWV decreased with empagliflozin (-3.1 ± 0.3 m/s) and sitagliptin (-1.6 ± 0.4 m/s), the difference being greater with empagliflozin (P< 0.01).

This difference in arterial stiffness appears to be derived from blood pressure lowering and decreased body weight with empagliflozin.

“If you have a cardiovascular patient with diabetes who is obese and has pre-hypertension, and not hypertension, the selection of empagliflozin in the second step instead of sitagliptin may have additional benefit in terms of reducing arterial stiffness, which is a significant cardiovascular risk factor,” said Dr. Efstathiou.

[Presentation title: Empagliflozin May Attenuate Adipose Tissue Inflammation and Arterial Stiffness in Normotensive Type 2 Diabetics. Abstract PS.08.11]

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