Class Recommendation for Jardiance (Empagliflozin) in Chronic Cardiovascular Disease Management

Recommendations Based on Patient Population

The American College of Cardiology recommends Empagliflozin (Jardiance) for patients with chronic coronary disease (CCD) who have type 2 diabetes, to reduce cardiovascular events, with a Class I recommendation 1, 2
The European Heart Journal recommends Empagliflozin (Class I) in patients with type 2 diabetes and established cardiovascular disease to reduce cardiovascular events 3, 4, 2
Empagliflozin has a Class I recommendation to reduce the risk of death in patients with type 2 diabetes and cardiovascular disease, according to the European Heart Journal 3, 4, 5

For patients with CCD and heart failure with LVEF ≤40%, the American College of Cardiology recommends SGLT2 inhibitors including empagliflozin (Class I) to reduce the risk of cardiovascular death and heart failure hospitalization, regardless of diabetes status 1
For patients with CCD and heart failure with LVEF >40%, the American College of Cardiology recommends empagliflozin (Class IIa) to decrease heart failure hospitalizations and improve quality of life, irrespective of diabetes status 1
The European Heart Journal recommends SGLT2 inhibitors including empagliflozin (Class I) to lower risk of heart failure hospitalization in patients with diabetes 3, 6

The European Heart Journal and the American Journal of Kidney Diseases recommend SGLT2 inhibitors including empagliflozin (Class I) to reduce progression of diabetic kidney disease 3, 7

The Class I recommendation for empagliflozin in patients with type 2 diabetes and cardiovascular disease is based on high-quality evidence (Level A) from randomized controlled trials, according to the European Heart Journal and the American College of Cardiology 3, 1, 2
The Class IIa recommendation for empagliflozin in heart failure with LVEF >40% is supported by moderate-quality evidence, according to the American College of Cardiology 1

The American College of Cardiology recommends empagliflozin for patients with heart failure with reduced ejection fraction (HFrEF, LVEF ≤40%) to reduce the risk of cardiovascular death and heart failure hospitalization, regardless of diabetes status 8
The European Heart Journal suggests that empagliflozin can be used in patients with HFrEF even when they are already on optimal heart failure therapy, including ACE inhibitors/ARBs, beta-blockers, and mineralocorticoid receptor antagonists 9
The American College of Cardiology recommends empagliflozin for patients with heart failure with preserved ejection fraction (HFpEF, LVEF >40%) to decrease heart failure hospitalizations and improve quality of life, regardless of diabetes status 8

The American College of Cardiology suggests reducing total daily insulin dose by approximately 20% when starting empagliflozin therapy if HbA1c is well-controlled at baseline, and considering weaning or stopping sulfonylureas or glinides to prevent hypoglycemia 10
The American College of Cardiology recommends considering stopping or reducing diuretic doses if there are signs of volume contraction when using empagliflozin 10

The American College of Cardiology advises discontinuing empagliflozin at least 3 days before planned surgery to prevent postoperative ketoacidosis 11
The European Heart Journal suggests that empagliflozin may be particularly beneficial in patients with both cardiomyopathy and diabetic kidney disease 9

The American College of Cardiology notes that genital mycotic infections are a common adverse effect of empagliflozin, and also warns of potential volume depletion and hypotension, especially when combined with diuretics 11

The European Heart Journal recommends empagliflozin to reduce cardiovascular death and major adverse cardiovascular events in patients with type 2 diabetes and established coronary artery disease, with a Class I, Level A recommendation 12

Empagliflozin provides a reduction in worsening nephropathy, with a hazard ratio of 0.61 (95% CI 0.53-0.70), as reported in Diabetes Care 13
In patients with peripheral artery disease, empagliflozin reduces cardiovascular death (HR 0.57; 95% CI 0.37-0.88) and all-cause mortality (HR 0.62; 95% CI 0.44-0.88), according to the European Heart Journal 12

The European Heart Journal recommends empagliflozin as a first-line treatment, with a Class I, Level A recommendation, and suggests adding metformin and other glucose-lowering agents as necessary to achieve HbA1c <7% (53 mmol/mol) 12
The European Heart Journal also recommends considering GLP-1 receptor agonists (liraglutide or semaglutide) as complementary therapy for additional cardiovascular risk reduction 12

In patients with CAD, diabetes, and heart failure with LVEF ≤40%, empagliflozin receives a Class I recommendation to reduce cardiovascular death and heart failure hospitalization, as reported in the Journal of the American College of Cardiology 14