Epicardial adipose tissue (EAT) is increasingly assessed as a cardiometabolic marker in type 2 diabetes mellitus (T2DM). A prospective single-arm study published in Echocardiography evaluated the association of empagliflozin with EAT thickness and cardiac function in adults with T2DM without established cardiovascular disease.

The study included 75 adults (mean age 58.5 ± 8.3 years; 44% male) receiving empagliflozin 10 mg once daily for 6 months while on stable oral therapy. Individuals with cardiovascular disease, heart failure, or renal dysfunction were excluded. Transthoracic echocardiography and laboratory parameters were assessed at baseline and follow-up.

EAT thickness decreased from 0.77 ± 0.07 cm to 0.69 ± 0.06 cm (p<0.001). Fasting plasma glucose (FPG) decreased from 182 ± 60.2 to 132 ± 16.2 mg/dL and glycated hemoglobin (HbA1c) from 9.17% ± 1.24% to 8.36% ± 1.01% (p<0.001). LDL-C, HDL-C, CRP, and NLR also showed significant changes. Diastolic indices improved, including E/e′ (6.88 to 6.64; p=0.011), IVRT (96.7 to 93.6 ms; p<0.001), and DT (214 to 210 ms; p<0.001), while LVEF remained stable. Smoking was associated with higher baseline EAT. ΔEAT showed no significant association with metabolic or inflammatory changes but had an inverse correlation with baseline EAT (r=−0.51; p<0.001).

These findings show that empagliflozin use was associated with reductions in EAT and changes in diastolic parameters in this cohort. The single-arm design and lack of a control group limit causal interpretation, and the results should be considered hypothesis-generating.