Comparative effects of empagliflozin and vildagliptin on inflammation and atrial function in patients with type 2 diabetes and coronary artery disease: EMPA-VILDA-Response trial.

Coronary artery disease (CAD) and type 2 diabetes mellitus (T2DM) continue to be leading causes of global morbidity and mortality. Although sodium-glucose cotransporter-2 (SGLT2) inhibitors have demonstrated cardioprotective benefits in patients with advanced cardiovascular disease, their effects compared to other antidiabetic agents remain less well characterized. This randomized, controlled trial aimed to compare the effects of empagliflozin (EMPA), an SGLT2 inhibitor, with vildagliptin (VILDA), a dipeptidyl peptidase-4 (DPP-4) inhibitor, on cardiac function and inflammatory biomarkers in CAD patients with T2DM. A total of 120 patients were randomized to receive either EMPA 10 mg/day or VILDA 50 mg/day for six months. Clinical outcomes assessed included glycemic control, lipid profiles, inflammatory biomarkers, and echocardiographic measures of myocardial function. Both treatment groups showed significant improvements in glycemic control and lipid profiles. However, patients in the EMPA group exhibited superior outcomes compared with VILDA group, including: decreased HbA1c levels (6.3 ± 0.9 vs. 6.8 ± 0.9; p = 0.002), hs-CRP (8.8 ± 1.1 vs. 9.7 ± 1.5; p < 0.001), sortilin (1.0 ± 0.6 vs. 1.7 ± 0.6; p < 0.001), TNF-α (1.2 ± 0.3 vs. 1.5 ± 0.3; p < 0.001), leptin levels (9.4 ± 1.7 vs. 10.1 ± 1.7; p = 0.02), and increased adiponectin (1.9 ± 0.7 vs. 1.4 ± 0.6; p < 0.001), Moreover, EMPA significantly improved atrial myocardial function, preserved ejection fraction (EF), E/E' ratio, left and right atrial strain (S), strain rate (SR), atrial volumes, and distensibility (p < 0.01). Empagliflozin not only improves metabolic and inflammatory profiles but also confers early benefits on cardiac structure and function in T2DM patients with CAD. These findings highlight the broader cardiovascular utility of SGLT2 inhibitors beyond glycemic control and support their growing role in cardio-protection within clinical practice.