Increased left ventricular (LV) mass is associated with future heart failure (HF), but preventive effects of sodium-glucose cotransporter 2 inhibitors (SGLT2i) in individuals without HF remain uncertain. A multicenter, double-blind, randomized, placebo-controlled superiority trial published in the Journal of Cardiac Failure evaluated the impact of empagliflozin on LV structure in older adults with overweight and HF risk factors.

A total of 191 individuals aged 60-84 years with body mass index (BMI) >28 kg/m² and at least one HF risk factor (hypertension, ischemic heart disease, stroke, or chronic kidney disease) were randomized 1:1 to empagliflozin 10 mg daily or placebo for 180 days. Individuals with HF or type 2 diabetes (T2D) were excluded. The primary endpoint was change in LV mass index (LVMI) from baseline to 180 days assessed by cardiac magnetic resonance imaging. Secondary endpoints included LV end-diastolic volume index (LVEDVI), LV end-systolic volume index (LVESVI), and LV ejection fraction (LVEF).

Among 165 participants completing imaging (median age 68 years, median BMI 31.8 kg/m², 67% male, median LVEF 65%), empagliflozin reduced LVMI compared with placebo (estimated treatment difference −1.9 g/m²; 97.5%CI −3.5 to −0.2; p=0.01). No significant differences were observed for LVEDVI, LVESVI, or LVEF.

Empagliflozin was associated with a modest reduction in LVMI in overweight older adults without HF. No significant changes were observed in LV volumes or systolic function.