Investigation of the effects of empagliflozin on ventricular repolarization heterogeneity in patients with diabetes and coronary artery disease.

• Grant number: 25/02353-5
• Support Opportunities: Scholarships in Brazil - Post-Doctoral
• Start date: May 01, 2025
• End date: April 30, 2027
• Field of knowledge: Health Sciences - Medicine - Medical Clinics
• Principal Investigator: Bruno Caramelli
• Grantee: Ariana Ester Fernandes
• Host Institution: Instituto do Coração Professor Euryclides de Jesus Zerbini (INCOR). Hospital das Clínicas da Faculdade de Medicina da USP (HCFMUSP). Secretaria da Saúde (São Paulo - Estado). São Paulo , SP, Brazil
• Associated research grant: 20/02668-2 - Translational research in cardiometabolic diseases: preclinical and clinical studies of the cardioprotective and antidiabetic mechanisms, AP.TEM

Abstract

Cardiovascular diseases are the leading cause of morbidity and mortality in diabetic patients. For several years, it has been required that new hypoglycemic medications undergo cardiovascular safety studies for approval. In 2015, the EMPA-REG OUTCOME, conducted for the approval of empagliflozin, a new sodium-glucose cotransporter 2 inhibitor, was the first study to provide evidence that an antidiabetic agent reduces cardiovascular events. The results showed a reduction in the primary endpoint (cardiovascular deaths, nonfatal myocardial infarction, and nonfatal stroke), cardiovascular mortality, and hospitalization for heart failure in patients with high cardiovascular risk type 2 diabetes who received empagliflozin in addition to standard treatment. It is noteworthy that the studied population was under optimized clinical treatment with antihypertensives, statins, and aspirin, and, especially, the difference in the primary endpoint relative to placebo became evident only 3 months after the start of treatment.The underlying mechanisms behind the surprising cardiovascular benefits of empagliflozin are not fully understood.The present project aims to investigate whether empagliflozin has antiarrhythmic effects. By analyzing the T-wave heterogeneity index, a new electrocardiographic risk marker associated with the prediction of cardiovascular risk, in diabetic coronary patients, we will verify if empagliflozin is associated with a reduction in electrical instability.