Diabetes Drug Can Treat and Reverse Heart Failure and Reduce Hospitalizations
Mount Sinai clinical trial results could help lead to FDA approval
Empagliflozin, a recently developed diabetes drug, can effectively treat and reverse heart failure in both diabetic and non-diabetic patients, according to researchers at the Icahn School of Medicine at Mount Sinai.
Their clinical trial showed that this medication can improve the heart’s size, shape, and function, leading to better exercise capacity and quality of life, which will reduce hospitalizations for heart failure patients. The results were presented on Friday, November 13, at the American Heart Association Scientific Sessions 2020 and simultaneously published in the Journal of the American College of Cardiology.
“Our clinical trial’s promising results show this diabetes drug can ameliorate lives of heart failure patients with reduced ejection fraction, enhance their exercise capacity, and improve their quality of life with little to no side effects. We expect this work will help lead to U.S. Food and Drug Administration approval of empagliflozin for this patient population in the coming months,” said first author Carlos Santos-Gallego, MD, postdoctoral fellow at the Icahn School of Medicine at Mount Sinai.
“Our study also identifies why this drug is effective: because it improves heart function, something that has not been understood until now,” Dr. Santos-Gallego said. “Many doctors are afraid of prescribing a drug they do not understand, and our findings will help clinicians feel more comfortable giving this to patients once approved. A cornerstone finding is that, although this drug was initially developed for diabetes, it is also incredibly effective in patients without diabetes.”
Importantly, the researchers noted that the drug did not appear to cause hypoglycemia, or low blood sugar, in non-diabetic patients.
For the trial, known as “EMPATROPISM,” researchers recruited 84 patients with chronic heart failure with reduced ejection fraction (EF)—the percentage of blood the left ventricle pumps with each contraction—and randomized them to treatment with empagliflozin or a placebo. All had baseline evaluations including cardiac magnetic resonance imaging, a cardiopulmonary exercise test on a bicycle wearing a face mask to text oxygen levels, a six-minute walk test, and quality-of-life questionnaires. Patients received treatment or placebo for six months, with some short safety visits at one and three months. At the six-month mark, patients went through the same tests.
Roughly 80 percent of the patients treated with empagliflozin showed significant improvement, and their hearts returned to near normal, the researchers found. This group had a 16.6 percent improvement in left ventricular ejection fraction at the six-month mark and their hearts pumped blood in a stronger way. Their hearts became smaller, less dilated because of less congestion and less fluid accumulation in the body, meaning that their heart failure became less severe, and the walls of the heart were less thick, meaning that the left ventricle could pump blood more easily. The placebo group showed no improvement; those patients either stayed at baseline or their condition got worse. They had a diminishing EF; their hearts were more dilated and thicker, and had an abnormal, more spherical, shape.
The study also showed that patients taking empagliflozin had roughly 10 percent improvement in their exercise levels, a statistically significant difference, while patients on the placebo arm showed no improvement. This demonstrated that the empagliflozin group became healthier, could do more everyday activities, and had an improved quality of life, putting those patients at less risk of hospitalization.
The study also identified, for the first time, why this drug is effective for treating heart failure. In heart failure, the heart goes through “adverse remodeling,” in which the left ventricle dilates, becomes thicker (hypertrophic) and more spherical, and pumps in a weaker way with a lower ejection fraction. The researchers demonstrated that this drug lessens and reverses this adverse remodeling. It reduces the dilation and hypertrophy of the left ventricle, helps the left ventricle pump more strongly (increasing the ejection fraction), and changes the shape of the left ventricle, making it more elongated and less spherical.
About the Mount Sinai Health System
Mount Sinai Health System is one of the largest academic medical systems in the New York metro area, with more than 43,000 employees working across eight hospitals, over 400 outpatient practices, nearly 300 labs, a school of nursing, and a leading school of medicine and graduate education. Mount Sinai advances health for all people, everywhere, by taking on the most complex health care challenges of our time — discovering and applying new scientific learning and knowledge; developing safer, more effective treatments; educating the next generation of medical leaders and innovators; and supporting local communities by delivering high-quality care to all who need it.
Through the integration of its hospitals, labs, and schools, Mount Sinai offers comprehensive health care solutions from birth through geriatrics, leveraging innovative approaches such as artificial intelligence and informatics while keeping patients’ medical and emotional needs at the center of all treatment. The Health System includes approximately 7,300 primary and specialty care physicians; 13 joint-venture outpatient surgery centers throughout the five boroughs of New York City, Westchester, Long Island, and Florida; and more than 30 affiliated community health centers. We are consistently ranked by U.S. News & World Report's Best Hospitals, receiving high "Honor Roll" status, and are highly ranked: No. 1 in Geriatrics and top 20 in Cardiology/Heart Surgery, Diabetes/Endocrinology, Gastroenterology/GI Surgery, Neurology/Neurosurgery, Orthopedics, Pulmonology/Lung Surgery, Rehabilitation, and Urology. New York Eye and Ear Infirmary of Mount Sinai is ranked No. 12 in Ophthalmology. U.S. News & World Report’s “Best Children’s Hospitals” ranks Mount Sinai Kravis Children's Hospital among the country’s best in several pediatric specialties. The Icahn School of Medicine at Mount Sinai is one of three medical schools that have earned distinction by multiple indicators: It is consistently ranked in the top 20 by U.S. News & World Report's "Best Medical Schools," aligned with a U.S. News & World Report "Honor Roll" Hospital, and top 20 in the nation for National Institutes of Health funding and top 5 in the nation for numerous basic and clinical research areas. Newsweek’s “The World’s Best Smart Hospitals” ranks The Mount Sinai Hospital as No. 1 in New York and in the top five globally, and Mount Sinai Morningside in the top 20 globally.