Heart scan signs predicted greater benefit from empagliflozin
Against placebo, empagliflozin’s hazard ratios—relative event rates over time—were 0.91, 0.64 and 0.49 for zero, one or multiple documented heart scan criteria.
Our read
Interventions- Studied:
- Randomized trial in 5,988 patients with heart failure with preserved ejection fraction (Placebo-controlled)
- What changed:
- Empagliflozin lowered heart failure hospitalization or cardiovascular death most with multiple scan abnormalities: hazard ratio 0.49 versus placebo
- The catch:
- Scan reliability and methods were uncontrolled, and scans could capture acute or stable heart failure
- Stake:
- Boehringer Ingelheim, which develops empagliflozin, funded the study.
- In the record:
- The 152nd paper on empagliflozin with results in people; 421 on record in all.
- Why it’s aging research:
- It studies an intervention with evidence of extending healthy life.
Editor of record: Boris Djordjevic · AgingResearch.News
Among 5,988 patients with heart failure and preserved heart squeezing function, an analysis of the EMPEROR-Preserved trial compared empagliflozin with placebo across ultrasound-defined groups. The groups reflected criteria for diastolic dysfunction, difficulty relaxing between heartbeats. At baseline, 3,766 patients had no documented dysfunction, 1,619 met one criterion and 603 met at least two.
The estimated treatment benefit for heart failure hospitalization or cardiovascular death increased across these groups. The hazard ratios were 0.91, 0.64 and 0.49, respectively, with lower values indicating greater benefit compared with placebo. Total heart failure hospitalizations followed the same pattern. Improvements in a questionnaire score covering symptoms and physical limitations at 52 weeks were consistent across groups. Safety profiles were also consistent across groups.
Why it matters
For heart failure care in later life, the analysis addresses whether ultrasound findings can help identify who may benefit most from a drug.
Caveats
The subgroup analysis could not reliably determine why treatment response differed across the scan-defined groups. The findings concern patients with heart failure and preserved squeezing function, not people without heart failure.
Where the evidence stands
Empagliflozin
- 162 independent labs in 43 countries
- 37 findings against
- 299 trials, 71 with no results posted
- Funders: Boehringer Ingelheim and others
- 134 of 632 findings with company ties
- 92 of 299 trials sponsored by its developers
From the paper
- Follow-up
… were randomized in a 1:1 ratio to double-blind treatment with once-daily empagliflozin 10 mg or matching placebo in addition to their usual therapy for HF and were followed up for a median of 26.2 months.
- Primary outcome
… with estimated HRs vs placebo of 0.54 (95% confidence interval CI 0.40–0.74) and 0.41 (95% CI 0.26–0.62) (P <.0001), respectively.
- Limitation
One important weakness is the lack of an echo central core laboratory to define the nature of the diastolic impairment seen in some patients in the trial.
Quoted word for word from the full text on academic.oup.com.
- Empagliflozin
- Diastolic dysfunction
- Heart failure with preserved ejection fraction
- Body weight
- Diastolic blood pressure
- Humans
Empagliflozin is part of Bryan Johnson's Blueprint
The paper
University of Sydney; University Hospital
European Journal of Heart Failure, Nov 5, 2026
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