SGLT2 inhibitor treatment stabilizes kidney function in patients who have had a heart attack

SGLT2 inhibitors have become a major drug used to treat diabetes, heart failure, and chronic kidney disease. However, there have been questions as to whether it is safe to use these drugs in patients after a recent heart attack due to concerns about harming kidney function in potentially unstable patients.

A secondary analysis of the EMPACT-MI trial, published in Nature Cardiovascular Research, demonstrates that the SGLT2 inhibitor empagliflozin preserved kidney function and was safe to initiate in heart attack patients. Researchers found that after heart attack patients were on the drug for two years, their kidney function was stable and unharmed, while patients on placebo had significant worsening of their kidney function.

Even in heart attack patients with poor kidney function, researchers found SGLT2 inhibitors reduced heart failure complications. This is important considering that drugs that are beneficial in patients without kidney disease sometimes don’t work for patients with kidney disease. This was not the case with empagliflozin.

Many heart attack patients who could benefit from SGLT2 inhibitors do not currently receive these drugs because many doctors fear they could damage kidney function. Results from this study, the largest trial to date of an SGLT2 inhibitor in patients with heart attacks, may change this.

Researchers randomized 6,522 patients hospitalized with a heart attack to either an SGLT2 inhibitor or placebo, on average five days after the heart attack. Patients were followed for an average of a year and a half.

Empagliflozin reduced total hospitalizations for heart failure by 33% (2.4 events per 100 person-years in the empagliflozin group and 3.6 events per 100 person-years in the placebo group) with consistent effects according to kidney function. The difference in eGFR change (a measure of kidney function) between empagliflozin and placebo was 4.1 ml/min/1.73 m²), indicating significant worsening of kidney function in the placebo group after two years.

Clinicians should be vigilant when it comes to treating patients who might benefit from SGLT2 inhibitors and not withhold therapy due to a recent heart attack or because of kidney disease, since these study results show these drugs will not impact kidney function.

“SGLT2 inhibitors are underused in clinical practice. These data provide reassurance of the safety of using this class of drugs when indicated—even in patients after a recent heart attack and if the kidney function is impaired,” says lead investigator Dr. Bhatt.

About the EMPACT-MI trial

EMPACT-MI trial (EMPAgliflozin for the prevention of Chronic heart failure and morTality after an acute Myocardial Infarction, NCT04509674) is a multicenter, randomized, parallel-group, double-blind, placebo-controlled superiority trial investigating the effect of empagliflozin on all-cause mortality and hospitalization due to heart failure in adults who have had a heart attack. Participants had no history of chronic heart failure and were eligible regardless of type 2 diabetes and chronic kidney disease status.

EMPACT-MI included more than 6,500 adults from 22 countries. Study participants were randomized to receive either empagliflozin 10 mg or placebo, once daily, both on top of standard of care within 14 days of hospital admission for heart attack. The EMPACT-MI clinical trial was conducted, analyzed, and reported by Boehringer Ingelheim in partnership with the Duke Clinical Research Institute (DCRI).

The primary results of the EMPACT-MI trial were presented at the Annual Scientific Session of the American College of Cardiology, held April 6–8, 2024, in Atlanta and were published in the New England Journal of Medicine.