DISCUSSION
angina, hyperglycemia, PH, diabetic, T2DM, chronic stable angina, glucotoxicity, RA, cardiovascular complications, lipotoxicity
EVENTS, HYPERGLYCEMIA, CHRONIC STABLE ANGINA, MYOCARDIAL ISCHEMIA, HEART FAILURE, CARDIOVASCULAR COMPLICATIONS
The EMPT‐ANGINA trial demonstrated that in individuals with concurrent T2DM and RA, adding empagliflozin to routine anti‐hyperglycemic therapies was linked to a substantial reduction in angina symptoms and improvement in exercise capacity compared to placebo.Given the increased risk of cardiovascular complications in patients with T2DM, the cautious selection of antianginal treatment appears to be a crucial concern.Antianginal therapy for diabetic patients with chronic stable angina appears to be a complex issue, partly because some of the pharmacological agents that alleviate angina may impair glucose regulation. In addition, unfavorable hemodynamic effects may make the patient less compliant.SGLT2 inhibitors are novel, approved oral antidiabetic agents that block sodium and glucose cotransporters on the luminal surface of the proximal convoluted renal tubules.Myocardial ischemia is no longer considered a mere imbalance between myocardial oxygen demands and/or coronary blood flow to the ischemic myocardium but might be an issue related to energy metabolism.Increased FA oxidation and hyperglycemia cause an accumulation of glucose and FA intermediate metabolites in the cells, resulting in lipotoxicity and glucotoxicity, respectively.Empagliflozin switches energy substrate preference from FA to glucose, resulting in the inhibition of cardiac FA oxidation and increasing the oxidation of pyruvate, leading to lower lactate production and less fall in myocytes' PH, which would be beneficial for the ischemic heart.Large‐scale studies have shown that SGLT2 inhibitors enhance cardiorenal function and lower cardiovascular events, particularly heart failure.Our data demonstrated a substantial decrease in HRR following empagliflozin, indicating that SGLT2 inhibitors may have antisympatholytic effects that might relieve angina symptoms by lowering resting HR and cardiac demand.