News | Heart Failure | April 19, 2019

Diabetes Drug May Reverse Heart Failure

Mount Sinai study finds drug could have new applications in non-diabetics

Diabetes Drug May Reverse Heart Failure

April 19, 2019 – Researchers at the Icahn School of Medicine at Mount Sinai have demonstrated that the recently developed antidiabetic drug empagliflozin can treat and reverse the progression of heart failure in non-diabetic animal models. Their study also shows that this drug can make the heart produce more energy and function more efficiently. The results were published in the April 23 issue of the Journal of the American College of Cardiology.1

“This drug could be a promising treatment for heart failure in both non-diabetic and diabetic patients,” said lead author Juan Badimon, M.D., professor of cardiology and director of the Atherothrombosis Research Unit at the Cardiovascular Institute at the Icahn School of Medicine at Mount Sinai. “Our research can lead to a potential application in humans, save lives and improve quality of life.”

Empagliflozin was approved by the U.S. Food and Drug Administration (FDA) in 2014. It limits renal sugar resorption and is the first drug in the history of type 2 diabetes proven to prolong survival. While diabetes patients are typically at higher risk of heart failure, past studies have suggested that those who take empagliflozin do not commonly develop heart failure. Those observations led a team of researchers to question if the drug contains a mechanism, independent of anti-diabetic activity, that is linked to heart failure prevention, and whether it could have the same impact on non-diabetics.

Investigators from the Atherothrombosis Research Unit tested the hypothesis by inducing heart failure in 14 non-diabetic pigs. For two months, they treated half of the animals with empagliflozin and the other group with a placebo. The team evaluated the pigs with cardiac magnetic resonance, 3-D echocardiography and invasive catheterization at three different points in the study (before inducing, one day after inducing and at the two-month mark). At two months, all animals in the group treated with empagliflozin experienced improved heart function. Specifically, those pigs had less water accumulation in the lungs (less pulmonary congestion, which is responsible for causing shortness of breath) and lower levels of biomarkers of heart failure. Importantly, the left ventricles had stronger contractions (enhanced systolic function), got smaller (less dilated) and were less thick (less hypertrophy), and the heart was a normal shape (less architectural remodeling).

The researchers also found that the drug addressed heart failure by improving cardiac metabolism. The hearts of pigs on the medication were consuming more fatty acids and ketone bodies (three related compounds — acetone, acetoacetic acid and beta-hydroxybutyric acid — produced during the metabolism of fats) and less glucose, as contrasted with heart failure patients (diabetic and non-diabetic), whose hearts consume more glucose and almost no fatty acids and produces less energy. This boost in metabolism helped the hearts produce more energy and function more strongly and efficiently.

“This study confirmed our hypothesis that empagliflozin is an incredibly effective treatment for heart failure and not only an antidiabetic drug. Moreover, this study demonstrated that empagliflozin is useful for heart failure independently of a patient’s diabetic status. Importantly, empagliflozin switches cardiac metabolism toward fatty acid and ketone body consumption, thus allowing the production of more energy in the heart,” explained co-lead author Carlos Santos-Gallego, M.D., postdoctoral fellow at the Icahn School of Medicine at Mount Sinai. “Empagliflozin may be a potentially effective treatment for heart failure patients. This is extremely important because heart failure is a disease with a mortality above 50 percent at five years. This study offers a new therapeutic strategy in heart failure, something badly needed given that there have not been new effective drugs for heart failure since the 1990s.”

The authors are currently studying whether empagliflozin is an effective heart failure treatment in non-diabetic human patients in the EMPATROPISM clinical trial.

For more information: www.onlinejacc.org

 

Reference

1. Santos-Gallego C.G., Requena-Ibanez J.A., San Antonio R., et al. Empagliflozin Ameliorates Adverse Left Ventricular Remodeling in Nondiabetic Heart Failure by Enhancing Myocardial Energetics. Journal of the American College of Cardiology, April 23, 2019. DOI: 10.1016/j.jacc.2019.01.056

Related Content

News | Heart Failure | July 09, 2020
July 9, 2020 – The Minneapolis Heart Institute Foundation (MHIF) is conducting additional research on a novel hydroge
Navin Kapur, M.D., Tufts Medical Center, shows preCardia device and its anatomical positioning in the patient to treat heart failure..

Navin Kapur, M.D., Tufts Medical Center, shows preCardia device and its anatomical positioning in the patient.

News | Heart Failure | June 23, 2020
June 23, 2020 — The U.S.
Patients with worsening heart failure and reduced ejection fraction who received the investigational drug vericiguat had a significantly lower rate of cardiovascular death or heart failure hospitalization compared with those receiving a placebo, based on research presented at the American College of Cardiology’s Annual Scientific Session Together with World Congress of Cardiology (ACC.20/WCC) #ACC20/#WCCardio
News | Heart Failure | March 29, 2020
March 29, 2020 — Patients with worsening heart failure and reduced ejection fraction who received the investigational
Dapagliflozin Reduces Heart Failure Worsening and Death in DAPA-HF Sub-analysis. #ACC20 #ACC2020
News | Heart Failure | March 28, 2020
March 28, 2020 — New data from a sub-analysis of the landmark Phase III...
News | Heart Failure | March 05, 2020
March 5, 2020 — Abbott recently received Breakthrough Device designation from the U.S.
Some of the new devices technologies to treat heart failure that are either in clinical trials or were recently cleared by the U.S. FDA. #heartfailure

Some of the new devices technologies to treat heart failure that are either in clinical trials or were recently cleared by the U.S. FDA. 

Feature | Heart Failure | February 21, 2020 | Dave Fornell, Editor
There are several new tools being added to the clinical armamentarium in the fight against...
Tufts Medical Center created a heart failure team approach to care for its patients. The program includes an interventional heart failure fellowship program, where interventional cardiologists learn more advanced care, as show here with an ECMO procedure being performed in a cath lab at Tufts. The interventional cardiologists learn how to better care for heart failure patients and interface with surgeons, intensivists and others on the HF care team. The operator is Nevin Kapur. Photo by Dave Fornell.

Tufts Medical Center created a heart failure team approach to care for its patients. The program includes an interventional heart failure fellowship program, where interventional cardiologists learn more advanced hemodynamic support methods, as shown here with an ECMO procedure being performed in a cath lab at Tufts. The interventional cardiologists learn how to better care for heart failure patients and interface with surgeons, intensivists and others on the HF care team. Photo by Dave Fornell.

Feature | Heart Failure | February 20, 2020 | Dave Fornell, Editor
There is no, single magic bullet in heart failure (HF) to easily reduce readmission rates or easily reverse this...
he U.S. Food and Drug Administration (FDA) has approved Carmat's investigational device exemption (IDE) application to start a U.S. early feasibility study (EFS) of its total artificial heart.
News | Heart Failure | February 12, 2020
February 12, 2020 — The U.S.