Diabetes Drug Can Treat and Reverse Heart Failure, Study Finds

New research has found that empagliflozin, a recently-developed type 2 diabetes drug, can also treat and reverse heart failure in patients, whether they have diabetes or not.

The November study, published in the Journal of the American College of Cardiology, recruited 84 patients with chronic heart failure with reduced ejection fraction, meaning the left side of the heart doesn't pump blood out to the body the way it should. The patients were randomly assigned to receive either empagliflozin or a placebo for six months. The patients went through a series of tests, both at the beginning of the study and at six months.

At the end of the study, about 80% of the patients who were treated with empagliflozin had a “significant improvement” in their heart condition, with their hearts returning to nearly normal functioning. Their hearts also became smaller and less dilated, and the walls of their heart were less thick. As a result, the left ventricle could pump blood more easily.

The placebo group had no improvement, with patients either staying at baseline or having their condition worsen.

Lead study author Carlos Santos-Gallego, MD, a postdoctoral fellow at the Icahn School of Medicine at Mount Sinai in New York, tells Verywell that previous research on animals found a link between empagliflozin and a reversal of heart failure. “What we have seen confirms the earlier results,” he says. “We have demonstrated that empagliflozin on top of optimal medical therapy can help patients with heart failure.”

About 6.2 million adults in the U.S. have heart failure, according to the Centers for Disease Control and Prevention (CDC).

How Empagliflozin Works

Empagliflozin is in a class of medications called sodium-glucose co-transporter 2 (SGLT2) inhibitors, according to MedlinePlus. The drug lowers blood sugar by causing the kidneys to get rid of more glucose (blood sugar) in the urine.

“From a diabetic point of view, having less sugar in the body is good,” Santos-Gallego says. “You’re also eliminating empty calories through the kidney, which can lead to some weight loss.”

How it Treats Heart Failure

“It was not completely clear before our research how empagliflozin treats heart failure,” Santos-Gallego says. However, his work found that the drug helps remodel the heart.

Heart failure is a chronic, progressive condition where the heart muscle isn’t able to pump enough blood to meet the body’s needs for blood and oxygen, according to the American Heart Association (AHA).

In heart failure, the heart goes through something called “adverse remodeling,” which is when the left ventricle, the thickest of the heart's chambers which pumps oxygenated blood to tissues in the body, becomes thicker, more spherical, and pumps in a weaker way than usual, Santos-Gallego explains. But empagliflozin reduces and reverses adverse remodeling. It specifically reduces the dilation and thickness of the left ventricle, helps it pump more strongly, and makes the left ventricle less spherical.

As for the link with diabetes, “diabetes is a risk factor for heart failure, and this medication helps to control diabetes,” Jamie Alan, PhD, assistant professor of pharmacology and toxicology at Michigan State University, tells Verywell. Empagliflozin isn’t the only drug that can do this, though. “Currently, there are two others in the class, [diabetes drugs] canagliflozin and dapagliflozin,” Alan says. In May, the Food and Drug Administration (FDA) approved dapagliflozin for the treatment of heart failure. Canagliflozin has been approved to lower the risk of hospitalization due to heart failure.

Santos-Gallego is hoping empagliflozin will join their ranks. “We knew that the drug was effective but now we understand the mechanism,” Santos-Gallego says. “Doctors like to understand the mechanisms, and we hope this will result in more clinicians prescribing this drug.”

In September, the FDA granted empagliflozin fast track designation to improve outcomes following a heart attack. Fast track is a process designed to facilitate the development, and expedite the review of drugs to treat serious conditions and fill an unmet medical need, per the FDA.

How Heart Failure is Currently Treated

There are several potential treatments for heart failure, and they generally include the following, per the CDC:

• Taking medicines
• Reducing sodium in the diet
• Drinking less liquids
• Using devices that remove excess salt and water from the blood
• Having a heart transplant or other surgery
• Getting daily physical activity