Anti-anginal Effects of Empagliflozin in Patients with Type 2 Diabetic and Refractory Angina; A Randomized, Double-Blind Placebo-Controlled Trial (Empt-Angina Trial)

Introduction: Sodium-glucose cotransporter 2 (SGLT2) inhibitors are emerging antidiabetic agents with various potential cardiovascular benefits. The EMPT-ANGINA trial examined the effect of empagliflozin on the angina burden in those with concurrent type 2 diabetes mellitus (T2DM) and refractory angina (RA). Method: In this 8-week, double-blind, randomized, placebo-controlled trial, 75 patients with T2DM and RA were randomly assigned to one of two groups: empagliflozin (n = 37) and placebo (n = 38). The primary outcome was an improvement in angina, which was assessed by the Seattle Angina Questionnaire (SAQ). The secondary outcomes of this study included alterations in the SAQ domains and exercise test components. Results: The mean age of individuals in the empagliflozin and placebo groups was 67.46 +/- 9.4 and 65.47 +/- 7.0 years, respectively (p =.304). Patients who received empagliflozin showed a significant improvement in both the primary endpoint, which was the SAQ Summary Score (192.73 +/- 20.70 vs. 224 +/- 25.36, p <.001) and the secondary endpoints. Exercise test components, including treadmill exercise duration, time till angina, 1mm ST-segment depression onset, and heart rate (HR) recovery, were all significantly improved in the empagliflozin group. This positive impact was reached with no clinically significant changes in resting and exertion HR or blood pressure. There were no significant side effects in the empagliflozin group (p =.125). Conclusion: Empagliflozin can be safely added as a metabolic modulator agent to existing antianginal medications in individuals with concurrent T2DM and RA to reduce angina symptoms and enhance exercise capacity with minimal side effects.