ArticleCardiovascular diabetology2023
Empagliflozin is associated with lower cardiovascular risk compared with dipeptidyl peptidase-4 inhibitors in adults with and without cardiovascular disease: EMPagliflozin compaRative effectIveness and SafEty (EMPRISE) study results from Europe and Asia.
Article in Cardiovascular diabetology, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.
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Who cites it
7 citing papers in PubMed, 11 citations in OpenAlex.
- Review
- SGLT2 Inhibitors and Prevention of Cardiovascular Events in Diabetes Patients with and Without Hypertension: A Nationwide Cohort Study.Journal of general internal medicine · 2026Article
- A cohort description and comparison of four European national diabetes registries for the REDDIE project.Diabetic medicine : a journal of the British Diabetic Association · 2025Article
- SGLT2 Inhibitors in the Management of Cardio-Renal-Metabolic Syndrome: A New Therapeutic Era.Medicina (Kaunas, Lithuania) · 2025Review
- Repurposing Diabetes Therapies in CKD: Mechanistic Insights, Clinical Outcomes and Safety of SGLT2i and GLP-1 RAs.Pharmaceuticals (Basel, Switzerland) · 2025Review
- Difference in outcome event coverage between insurance-based and hospital-based databases: a methodological study of diabetes drug use and cardiovascular events in Japan.Frontiers in pharmacology · 2025Article
- Bidirectional Mediation and Synergistic Mortality Risks in Diabetes and Cardiovascular Disease: Evidence From NHANES 2005-2018.Journal of diabetes research · 2025Article
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Authors and funding
31 authors at 20 institutions in 13 countries.
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No grant is acknowledged in the PubMed record.
Abstract
backgroundStudies that have reported lower risk for cardiovascular outcomes in users of Sodium-Glucose Cotransporter-2 Inhibitors (SGLT-2i) are limited by residual cofounding and lack of information on prior cardiovascular disease (CVD). This study compared risk of cardiovascular events in patients within routine care settings in Europe and Asia with type 2 diabetes (T2D) initiating empagliflozin compared to dipeptidyl peptidase-4 inhibitors (DPP-4i) stratified by pre-existing CVD and history of heart failure (HF). METHODS AND
resultsAdults initiating empagliflozin and DPP-4i in 2014-2018/19 from 11 countries in Europe and Asia were compared using propensity score matching and Cox proportional hazards regression to assess differences in rates of primary outcomes: hospitalisation for heart failure (HHF), myocardial infarction (MI), stroke; and secondary outcomes: cardiovascular mortality (CVM), coronary revascularisation procedure, composite outcome including HHF or CVM, and 3-point major adverse cardiovascular events (MACE: MI, stroke and CVM). Country-specific results were meta-analysed and pooled hazard ratios (HR) with 95% confidence intervals (CI) from random-effects models are presented. In total, 85,244 empagliflozin/DPP4i PS-matched patient pairs were included with overall mean follow-up of 0.7 years. Among those with pre-existing CVD, lower risk was observed for HHF (HR 0.74; 95% CI 0.64-0.86), CVM (HR 0.55; 95% CI 0.38-0.80), HHF or CVM (HR 0.57; 95% CI 0.48-0.67) and stroke (HR 0.79; 95% CI 0.67-0.94) in patients initiating empagliflozin vs DPP-4i. Similar patterns were observed among patients without pre-existing CVD and those with and without pre-existing HF.
conclusionThese results from diverse patient populations in routine care settings across Europe and Asia demonstrate that initiation of empagliflozin compared to DPP-4i results in favourable cardioprotective effects regardless of pre-existing CVD or HF status.
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