Jardiance and Heart DiseaseWednesday, September 02, 2015
A new study states Jardiance (Empaglifluzin, Eli Lilly and Boehringer Ingelheim) reduces the risk of heart attacks, strokes and other cardiovascular damage. Jardiance is a sodium glucose transport (SGLT-2 inhibitor) inhibitor, and is indicated as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes.
A three-year placebo controlled study that was conducted using 7,000 patients, who were taking multiple medications including for diabetes, hyperlipidemia, and hypertension, showed that Jardiance delayed the time until patients expired due to cardiovascular disease or suffered a heart attack or stroke. These results are encouraging given the fact that Jardiance may potentially cause intravascular volume contraction and may lead to dehydration.
Dehydration has negative effects on organs and bodily functions, including the heart and cardiovascular system. The body tracks circulatory system pressure through baroreceptors in the walls of major blood vessels in the chest and neck. In cases of dehydration, blood volume decreases, so vessel walls do not stretch as much as they should. Baroreceptors relay this information to the brain, which boosts heart rate to compensate for the reduced blood volume. Dehydration can lead to increased blood pressure and reduction of blood volume. The body compensates by retaining more sodium in the blood. And high blood-sodium concentrations can lead to high blood pressure.
Jardiance has been reported to also cause symptomatic hypotension, particularly in patients with renal impairment, the elderly, in patients with low systolic blood pressure, and in patients on diuretics. The incidence of volume depletion-related adverse reactions and urinary tract infections increased in patients ≥75 years treated with Jardiance.
In addition, Jardiance is reported to increases serum creatinine and decreases epidermal growth factor receptor (eGFR). Renal function monitoring is recommended prior to initiating the medication and periodically thereafter. More frequent monitoring is recommended with eGFR below 60 mL/min/1.73 m2. Jardiance should be discontinued in patients with a persistent eGFR less than 45 mL/min/1.73 m2.
Furthermore, Jardiance may potentially affect cardiac function through interaction with other concomitant medications. Coadministration of jardiance with diuretics is reported to increase urine volume and frequency of voids, which might enhance the potential for volume depletion.
The aforementioned study highlights the fact that although the potential for cardiac adverse effects exists, the risk of cardiovascular events including heart attack and stroke may be reduced for patients on Jardiance. The news may make clinicians believe that Jardiance may have less risk for cardiovascular events compared to other SGLT-2 inhibitors. However, we should be aware that patients should be monitored to ensure that Jardiance does not expose patients to adverse effects. I believe that close monitoring of patients’ renal function, symptoms of dehydration, and signs and symptoms of change in blood pressure after initiating of therapy with Jardiance will keep patients safe.
Once closely monitored, the patients will be at less risk for macrovascular disease. As a clinician, I am however concerned about those patients that will not be properly monitored due to failure to monitor blood pressure at home and subsequent failure to return for follow up appointments.These patients may then be at higher risk for volume depletion and dehydration. In patients whose lifestyle and concomitant medication therapy necessitate closer monitoring, I would be more reluctant to start Jardiance if they have a history of missed provider appointments. Every patient should be evaluated individually to ensure that prescribed medication therapy not only improves glycemic control but also reduces the risk of macrovascular disease that include heart attacks, strokes, and other cardiovascular damage.