Ansar Farrukh, Azzam Abdullah, Zafar Usman, Ahmed Sabeeh, Ghauri Fatima K, Khan AbdulRehman M, Mehmood Khan Abdul Rafay, Khalil Muhammad Umair, Iftikhar Hamdah, Faiz Abdul Rehman, Ahmad Muhammad Bilal
Department of Medicine, Alkhidmat Raazi Hospital, Rawalpindi, PAK.
Department of Neurology, National Hospital for Neurology and Neurosurgery, London, GBR.
Cureus. 2025 Aug 15;17(8):e90150. doi: 10.7759/cureus.90150. eCollection 2025 Aug.
Cardiovascular disease is a principal cause of morbidity and mortality worldwide, disproportionately affecting individuals with type 2 diabetes mellitus (T2DM) and heart failure. Empagliflozin, a sodium-glucose cotransporter 2 inhibitor, has shown promising cardioprotective effects beyond its glucose-lowering properties. This systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, involving a comprehensive literature search of PubMed, Scopus, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) from inception to May 2025. Randomized controlled trials evaluating empagliflozin in adult patients with T2DM or heart failure and reporting cardiovascular outcomes were included. A total of 13 RCTs comprising 21,669 participants were synthesized, encompassing a broad spectrum of populations, including high-risk T2DM, chronic heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF), and post-myocardial infarction cohorts. Empagliflozin was consistently associated with significant reductions in major adverse cardiovascular events, notably a 14-38% reduction in cardiovascular mortality and a 23-35% reduction in heart failure hospitalizations across key trials, such as EMPA-REG OUTCOME, EMPEROR-Reduced, and EMPEROR-Preserved. Smaller mechanistic studies highlighted additional benefits, including improvements in left ventricular function, cardiac remodeling, exercise capacity, and hemodynamic parameters. The safety profile of empagliflozin was favorable, with the main adverse event being an increased incidence of mild genital infections, and no excess in severe adverse or hypoglycemic events. Despite some heterogeneity in trial populations and follow-up, current evidence robustly supports empagliflozin as an effective and safe strategy to reduce cardiovascular risk in patients with T2DM and heart failure. Further research is warranted to explore long-term outcomes and expand indications to broader patient populations.
心血管疾病是全球发病和死亡的主要原因，对2型糖尿病（T2DM）患者和心力衰竭患者的影响尤为严重。恩格列净是一种钠-葡萄糖协同转运蛋白2抑制剂，除了具有降糖作用外，还显示出有前景的心脏保护作用。本系统评价按照系统评价和Meta分析的首选报告项目（PRISMA）指南进行，对PubMed、Scopus、Embase和Cochrane对照试验中央注册库（CENTRAL）从建库至2025年5月进行了全面的文献检索。纳入评估恩格列净在成年T2DM或心力衰竭患者中应用并报告心血管结局的随机对照试验。共综合了13项随机对照试验，涉及21,669名参与者，涵盖了广泛的人群，包括高危T2DM、射血分数降低的慢性心力衰竭（HFrEF）、射血分数保留的心力衰竭（HFpEF）以及心肌梗死后队列。在关键试验（如EMPA-REG OUTCOME、EMPEROR-Reduced和EMPEROR-Preserved）中，恩格列净始终与主要不良心血管事件的显著减少相关，尤其是心血管死亡率降低14%-38%，心力衰竭住院率降低23%-35%。规模较小的机制研究突出了其他益处，包括左心室功能、心脏重塑、运动能力和血流动力学参数的改善。恩格列净的安全性良好，主要不良事件是轻度生殖器感染的发生率增加，严重不良事件或低血糖事件无增多。尽管试验人群和随访存在一些异质性，但目前的证据有力地支持恩格列净作为降低T2DM和心力衰竭患者心血管风险的有效且安全的策略。有必要进一步研究以探索长期结局，并将适应证扩展到更广泛的患者群体。
