Discussion
death, cMRI-measured LV remodelling, pre-diabetes, T2DM, diabetes
REGRESSION, PRE-DIABETES, DIABETES
This post hoc analysis of the EMPA-HEART CardioLink-6 trial revealed that while LVM regression occurred in both South Asian and non-South Asian participants following empagliflozin use for 6 months, there was no meaningful difference in empagliflozin-associated LVMi change between the two groups. Likewise, there was no meaningful between-group treatment-associated differences for LV volumes and LVEF.Given that over half of the world’s population with pre-diabetes and diabetes are of Asian descent [Comprehensive findings from CV, kidney and HF trials with SGLT2 inhibitors since 2015 have persuaded diabetes, CV, kidney and HF clinical guideline writing committees to revise and update their recommendations more frequently than previous iterations. However, whether individuals of non-White European ancestry derive comparable benefits to those reported in the practice changing SGLT2 inhibitor trials remains unclear since most of the trial participants were of White European descent.A meta-analysis that included five SGLT2 inhibitor trials – three CV outcome trials of T2DM cohorts and two with participants living with HF – suggested that participants of Asian descent reaped greater CV death reduction/HF hospitalisation benefits relative to the White European individuals [Aside from the EMPA-HEART CardioLink-6 investigators, five other groups have described cMRI-measured LV remodelling findings following SGLT2 inhibitor exposure. While all were randomised placebo-controlled trials, two followed less than 70 participants [This study has some strengths. First, the data were derived from a randomised controlled study that utilised gold standard cMRI methodologies to measure the LV parameters in a blinded fashion. Second, the sizes of the South Asian and non-South Asian groups were similar, and the baseline characteristics were relatively balanced. This work has some limitations. First, the overall sample size was small and the study duration short, thus limiting the generalisability of the findings. Second, the ethnic heterogeneity within the non-South Asian arm likely culminated in an imbalanced distribution of CV risk factors; likewise, since specific South Asian ancestry data were not collected, it is unknown how diverse the CV risk profiles among the South Asian patients was.