The effect of empagliflozin on vascular remodeling related to cardiovascular well-being and sustainable health outcome: A literature review

¹ Doctoral Program of Medical Science, Faculty of Medicine, Airlangga University, Surabaya, Indonesia
² Department of Cardiology and Vascular Medicine, Faculty of Medicine, Airlangga University – Dr. Soetomo Academic General Hospital, Surabaya, Indonesia
³ Faculty of Medicine, Airlangga University, Surabaya, Indonesia
⁴ Department of Cardiology, National University Heart Centre, National University Health System, Singapore
⁵ Faculty of Medicine, State University of Surabaya, Surabaya, Indonesia

^* Corresponding author: bsp49@fk.unair.ac.id

Abstract

Cardiovascular disease (CVD) is the most common cause of mortality in patients with diabetes mellitus (DM). The reduction of CVD, which is a non-communicable disease (NCD), serves as a crucial indicator of Sustainable Development Goal (SDG) 3 on Good Health and Well-being. Empagliflozin is an anti-diabetic agent that plays an essential role in reducing the risk of adverse outcomes associated with CVD in addition to lowering the glycaemic effect. Therefore, this study aims to conduct a literature review using data obtained from PubMed and Google Scholar to investigate empagliflozin effects on the progression of vascular remodeling. Sodium-glucose co-transporter 2 inhibitor (SGLT2i) is a class of antidiabetic agents that has shown positive effects on pathological cardiovascular remodeling. The pathogenesis of vascular disease in DM cannot be dissociated from the engagement of endothelial cells (ECs) and vascular smooth muscle cells (SMCs). An example of SGLT2i known as Empagliflozin is used to enhance the bioavailability of nitric oxide (NO) produced by the endothelium, thereby restoring endothelium-dependent vasodilation in DM patients. Furthermore, it inhibits the inflammatory response by maintaining the structural integrity of endothelial glycocalyx. In SMCs, empagliflozin upregulates the vascular beneficial improvement through reactive oxygen species (ROS). The administration of this drug has been observed to induce the formation of circulating pro-vascular cell subsets in individuals without DM.