Effects of Empagliflozin on Cardiovascular Outcomes Are Consistent Across Sociodemographic Subgroups: A Real-World Analysis From the EMPRISE Study
Authors' conclusion
Empagliflozin reduced cardiovascular events across sociodemographic and CVD subgroups compared with both DPP4is and GLP-1RAs, with higher absolute benefits observed in those with prevalent CVD.
Study context
- Population
- Propensity score-matched adults aged ≥65 years with T2D, Medicare claims 2014–2020
- Exposure
- Empagliflozin vs DPP-4i and vs GLP-1 RA
- Outcome
- Heterogeneity of empagliflozin effects on major adverse cardiovascular events (MACE), HHF and all-cause mortality across sociodemographic and CVD subgroups
Methodological detailspropensity score-matched, real-world, Medicare claims data 2014-2020, subgroup analysis
- Propensity score-matched
- Real-world
- Medicare claims data 2014-2020
- Subgroup analysis
Main finding
As reported in the abstract
Effect heterogeneity across subgroups
- Vs DPP4is: effect heterogeneity by baseline cardiovascular disease (CVD) for all outcomes on the IRD scale, but only for hospitalization for heart failure (HHF) on the HR scale
- Vs GLP-1RAs: effect heterogeneity for HHF by baseline CVD on the IRD scale
- No effect heterogeneity by sociodemographic factors; numeric trend to greater absolute benefit at age ≥75 vs 65-74 years
Observational data: associations, not effects.
Further findings
| Outcome | HR | |
|---|---|---|
| MACE, overall, vs DPP4isEmpagliflozinvs DPP4is | 0.77 (99.9% CI 0.69–0.85) | |
| HHF, overall, vs DPP4isEmpagliflozinvs DPP4is | 0.72 (CI 0.67–0.79) | |
| All-cause mortality, overall, vs DPP4isEmpagliflozinvs DPP4is | 0.66 (CI 0.57–0.76) | |
| HHF, overall, vs GLP-1RAsEmpagliflozinvs GLP-1RAs | 0.88 (CI 0.81–0.95) | |
| 0.512Hazard ratio (log scale) |
| Outcome | IRD |
|---|---|
| MACE, overall, vs DPP4isEmpagliflozin vs DPP4is | −10.3 (99.9% CI −14.1 to −6.4) |
| HHF, overall, vs DPP4isEmpagliflozin vs DPP4is | −18.3 (CI −22.9 to −13.6) |
| All-cause mortality, overall, vs DPP4isEmpagliflozin vs DPP4is | −8.6 (CI −11.4 to −5.8) |
| HHF, overall, vs GLP-1RAsEmpagliflozin vs GLP-1RAs | −6.9 (CI −10.8 to −3.1) |
Original publication
Effects of Empagliflozin on Cardiovascular Outcomes Are Consistent Across Sociodemographic Subgroups: A Real-World Analysis From the EMPRISE Study. Diabetes Care. Published 21 September 2026. doi:10.
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