Presence of microvascular disease in patients with both type 2 diabetes (T2D) and cardiovascular (CV) disease increases the risk for heart failure and hospitalization for heart failure, according to study results published in the Journal of the American College of Cardiology.

Researchers completed a post hoc analysis of data from the EMPA-REG OUTCOME trial (Empagliflozin Cardiovascular Outcome Event Trial in Type 2 Diabetes Mellitus Patients) to assess the association of microvascular disease and CV events in patients with T2D. For the EMPA-REG OUTCOME trial, patients with diagnosed T2D and established CV disease were randomly assigned to receive empagliflozin (10 mg or 25 mg) or a placebo plus standard care. Patients were monitored for CV death, nonfatal myocardial infarction, nonfatal stroke, and hospitalization for heart failure.

Of the 7020 patients included in the trial, 48.7% had microvascular disease at baseline. Of the patients with microvascular disease at baseline, 69.4% had T2D for >10 years, 63% had prevalent insulin use, and 12.5% had heart failure. Mean estimated glomerular filtration rate was 70.76 mL/min/1.73 m² in patients with existing microvascular disease. There was a higher risk for subsequent hospitalization for heart failure (hazard ratio [HR], 1.63; 95% CI, 1.06-2.49; P =.0245) and CV death and hospitalization for heart failure (HR, 1.30; 95% CI, 0.97-1.73; P =.0751) for patients in the placebo cohort with microvascular disease compared with those without microvascular disease. The use of empagliflozin reduced the risk for CV events regardless of the presence of microvascular disease.

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One limitation of this study was that patients with microvascular abnormalities may not have been reported as having microvascular disease if they did not have clinical manifestations.

The researchers concluded that “in people with T2D the [coexistence] of microvascular disease in the setting of established macrovascular disease is associated with increased cardiovascular risk.”

The EMPA-REG OUTCOME trial was funded by the Boehringer Ingelheim & Eli Lilly companies. Several authors also note disclosures. Please refer to the original reference for a complete list of authors’ disclosures.


Verma S, Wanner C, Zwiener I, et al. Influence of microvascular disease on cardiovascular events in type 2 diabetes [published online March 5, 2019]. J Am Coll Cardiol. doi:10.1016/j.jacc.2019.03.002

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This article originally appeared on Endocrinology Advisor