One reason diabetes is so devastating, in the big picture, is because of how closely it’s tied to heart disease. People with both type 1 and type 2 diabetes have a higher risk of certain forms of cardiovascular disease, and people with type 2 are at an especially high risk of heart disease related to higher blood pressure, elevated or abnormal cholesterol and triglyceride levels, and obesity. For this reason, screening for cardiovascular disease risk factors is a regular and important part of diabetes care.
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Cardiovascular risks and benefits are also an important consideration for any diabetes drug — both when the U.S. Food and Drug Administration (FDA) is considering whether to approve a new drug, and when you and your doctor are deciding whether a drug is right for you. Some diabetes drugs are tied to cardiovascular benefits in addition to their effect on blood glucose levels. Metformin — considered the first-line drug for type 2 diabetes — is probably the most prominent example, with possible benefits in people with heart failure as well as a potentially protective effect against dementia in people with diabetes.
Other diabetes drugs have been in the spotlight recently for their beneficial effects in people with heart failure. One of them, Jardiance (empagliflozin), is an SGLT2 inhibitor that lowers blood glucose by preventing glucose absorption in the kidneys, resulting in glucose being eliminated in a person’s urine. But it also appears to improve heart function in people with a common form of heart failure — including people without diabetes, as a new study shows.
Benefits in heart function, quality of life
In the study, published in the Journal of the American College of Cardiology, Jardiance was found to improve the function of the heart’s left ventricle — its main pumping chamber — in people with heart failure with reduced ejection fraction (HFrEF). This type of heart failure means that a person’s ejection fraction — a measure of how much blood the left ventricle pumps out with each heartbeat — is less than 40%.
The study had 84 participants, all of whom had with HFrEF but didn’t have diabetes. They were randomly assigned to take either 10 milligrams of Jardiance, or a placebo (inactive pill), once daily for six months. Researchers were interested not only in potential improvements in heart function, but also in how the treatment might affect participants’ reported quality of life.
After six months, there were several notable differences between the Jardiance group and the placebo group. Jardiance was associated with a reduction in volume in the left ventricle — indicating better function — both during heartbeats (end-systolic volume, reduced by an average of 26.6 ml versus 0.5 ml) and between heartbeats (end-diastolic volume, reduced by 25.1 ml versus 1.5 ml). Compared with placebo, Jardiance was also associated with a reduction in the mass of the left ventricle, down by 17.8 grams versus 4.1 grams. The actual measure of ejection fraction — how much blood the heart pumps out — went up too, by 6% compared with just 0.1% in the placebo group.
What’s more, members of the Jardiance group reported having a better quality of life than the placebo group, based on a standard questionnaire. They also experienced functional benefits — including better peak oxygen consumption in an exercise test (1.1 mL/min/kg versus. 0.5 mL/min/kg) and an ability to walk over twice as far in a six-minute walking test (81 meters versus 35 meters).
Growing use of diabetes drugs for other conditions
This latest study fits a trend of diabetes drugs being tested as treatments for other health conditions, often with promising results. Another drug in the SGLT2 inhibitor family, Farxiga (dapagliflozin) was approved last year as a treatment for HFrEF in the United States, so it was logical to try out Jardiance for the same condition.
“Our observations suggest that SGLT2 inhibitors could become a new therapeutic strategy for the treatment of HFrEF patients independently of their diabetic status,” the researchers wrote. It remains to be determined, they note, whether Jardiance could benefit people with heart failure who don’t have reduced ejection fraction.
Want to learn more about protecting your heart? Read “Does Diabetes Hurt Your Heart?” “Fight Off Heart Disease With These Five Heart-Healthy Foods” and “Lower Your Risk of Heart Disease.”