Effect of empagliflozin on cardiac remodelling in South Asian and non-South Asian individuals: insights from the EMPA-HEART CardioLink-6 randomised clinical trial

• Type of Material: Article
• Authors: William Barbour, Western University; Erika Wolff, University College Cork; Pankaj Puar, University of Toronto; Makoto Hibino, Emory University; Ehab Bakbak, University of Toronto; Aishwarya Krishnaraj, University of Toronto; Raj Verma, St. Michael's Hospital of Unity Health Toronto; Meena Verma, St. Michael's Hospital of Unity Health Toronto; Adrian Quan, St. Michael's Hospital of Unity Health Toronto; Andrew T. Yan, University of Toronto; Kim A. Connelly, University of Toronto; Hwee Teoh, St. Michael's Hospital of Unity Health Toronto; c. David Mazer, University of Toronto; Subodh Verma, University of Toronto
• Language: English
• Date: 2023-11-15
• Publisher: Springer Nature
• Publication Version: Final Published Version
• Copyright Statement: © 2023, The Author(s)
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): https://doi.org/10.1186/s12872-023-03549-5
• Title of Journal or Parent Work: BMC Cardiovascular Disorders
• Volume: 23
• Start Page: 557
• Grant/Funding Information: The EMPA-HEART CardioLink-6 trial was supported by an unrestricted investigator-initiated study grant from Boehringer Ingelheim.
• Keywords: SGLT2 inhibition; South Asian ethnicity; Coronary artery disease; Left ventricular mass regression; Type 2 diabetes mellitus
• Research Categories: Health Sciences, General; Health Sciences, Pharmacology

Abstract

Background This exploratory sub-analysis of the EMPA-HEART CardioLink-6 trial examined whether the previously reported benefit of the sodium-glucose cotransporter 2 (SGLT2) inhibitor empagliflozin on left ventricular (LV) mass (LVM) regression differs between individuals of South Asian and non-South Asian ethnicity. Methods EMPA-HEART CardioLink-6 was a double-blind, placebo-controlled clinical trial that randomised 97 individuals with type 2 diabetes mellitus (T2DM) and coronary artery disease (CAD) to either empagliflozin 10 mg daily or placebo for 6 months. LV parameters and function were assessed using cardiac magnetic resonance imaging. The 6-month changes in LVM and LV volumes, all indexed to baseline body surface area, for South Asian participants were compared to those for non-South Asian individuals. Results Compared to the non-South Asian group, the South Asian sub-cohort comprised more males, was younger and had a lower median body mass index. The adjusted difference for LVMi change over 6 months was -4.3 g/m2 (95% confidence interval [CI], -7.5, -1.0; P = 0.042) for the South Asian group and -2.3 g/m2 (95% CI, -6.4, 1.9; P = 0.28) for the non-South Asian group (Pinteraction = 0.45). There was no between-group difference for the adjusted differences in baseline body surface area-indexed LV volumes and LV ejection fraction. Conclusions There was no meaningful difference in empagliflozin-associated LVM regression between South Asian and non-South Asian individuals living with T2DM and CAD in the EMPA-HEART CardioLink-6 trial.