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Fig. 2 | Cardiovascular Diabetology

Fig. 2

From: Rationale and design of a multicenter placebo-controlled double-blind randomized trial to evaluate the effect of empagliflozin on endothelial function: the EMBLEM trial

Fig. 2

Rationale for the EMBLEM trial. Recent studies have demonstrated that the effects of SGLT2 inhibitors on CV pathways, other than those implicated in glucose-lowering, are multifactorial and possibly result in improved CV outcomes. However, no evidence is currently available to show the effects of SGLT2 inhibitors on endothelial function; black arrow shows unestablished pathway, which is a key target in the present trial. Therefore, the EMBLEM trial seeks to assess the effect of empagliflozin on endothelial function through the beneficial effects of SGLT2 inhibitor on other relating CV pathways, such as arterial function and SNS activity, in patients with T2DM and established CV disease. Blue arrows show established or expected SGLT2 inhibitor-mediated effects. BP blood pressure, BW body weight, CV cardiovascular, eGFR estimated glomerular filtration rate, L-FABP liver-type fatty acid-binding protein, LVEF left ventricular ejection fraction, NT-proBNP N-terminal pro-brain natriuretic peptide, PWV pulse-wave velocity, RH-PAT reactive hyperemia peripheral arterial tonometry, SGLT2 sodium–glucose cotransporter 2, SNS sympathetic nervous system, T2DM type 2 diabetes mellitus

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