One Substance
to Treat Various

Understanding the connections between different diseases can provide the key to using the same drug to treat a variety of disorders. By working together across different areas of study, researchers from Boehringer Ingelheim are discovering new treatments for severe diseases and disorders, including heart failure.

Boehringer Ingelheim has been researching the interactions between different diseases for many years. “We draw on this experience to uncover the links between diseases and find more effective ways to treat them,” said Dr. Søren Tullin, Global Head of Cardiometabolic Diseases Research at Boehringer Ingelheim.

An open-door policy helps make this happen. “Our researchers use working groups, office visits, and video calls to stay in touch and share the latest information between divisions,” said Tullin. Thanks to their methodical research, innovative thinking, and a drop of luck, the experts at Boehringer Ingelheim recently demonstrated the beneficial impact that empagliflozin can have for people with heart conditions.

Type 2 Diabetes — a Global Health Problem

More than 460 million adults worldwide have diabetes, of which approximately 90 percent have type 2 diabetes, the majority thereof caused by being overweight and a lack of exercise. The prevalence of the disease is increasing in many countries – even among children and adolescents. Studies have shown that type 2 diabetes in connection with cardiovascular disease can reduce the lifespan by up to twelve years. The risk of dying from cardiovascular disease is up to two times higher in people with diabetes.

The body functions affected by diabetes interact in complex ways: High blood sugar can lead to fatty deposits in blood vessels, constricting the arteries and lowering the amount of oxygen available to the body. Blocked coronary arteries can lead to a heart attack and heart failure.

Heart failure takes many forms. One of them is heart failure with reduced ejection fraction (HFrEF). This happens when the muscle of the left ventricle is damaged and unable to pump enough blood into the circulatory system. Another variation is heart failure with preserved ejection fraction (HFpEF), where the left ventricle is stiffer than normal and there is less blood in the ventricle, not allowing the body to get enough oxygen.

The obesity pandemic

Obesity is a chronic disease that results from an imbal­ance between energy intake and expenditure. The global rates of obesity have seen a dramatic increase in the last decade, with some describing it as a pandemic. Worldwide, obesity has nearly tripled since 1975. It is considered an epidemic and the largest chronic disease globally. The World Health Organization (WHO) estimated in 2016 that more than 1.9 billion people, 18 years and over, were overweight and, of these, over 650 million were obese. Obesity is associated with serious complications and is the root cause of multiple associated diseases including type 2 diabetes mellitus, hypertension, chronic kidney disease, non-alcoholic steatohepatitis (NASH), and pain – resulting in tremendous societal burden.

Weight loss not only prevents but also effectively treats the obesity-related comorbidities. As an example, efficient and sustained weight loss results in the long-term remission of diabetes and a highly significant reduction in cardiovascular risk.

Boehringer Ingelheim is working on innovative concepts to meet the high demand for new anti-obesity therapies with a focus on superior and sustainable weight loss, as well as fewer side effects than current therapies.

Hope on the Horizon for People with Heart Conditions

Heart failure is a common problem, affecting more than 60 million people worldwide. Approximately half of them suffer from heart failure with preserved ejection fraction, a condition for which treatment options have been limited. “Until recently, we didn’t really have any treatment for patients with heart failure with preserved ejection fraction that had a solid scientific basis,” said Dr. Waheed Jamal, Head of Medicine Therapeutic Area Cardiometabolism & Respiratory at Boehringer Ingelheim.

That won’t be the case for much longer, according to the EMPEROR heart failure trials undertaken by the Boehringer Ingelheim and Lilly Alliance that explore the safety and efficacy of empagliflozin in patients with chronic heart failure with reduced and preserved ejection fraction. The EMPEROR trials found that the drug significantly reduced the risk of cardiovascular death or hospitalization for patients with heart failure with preserved ejection or with reduced ejection fraction, regardless of whether a patient had type 2 diabetes or not. In June 2021, the European Commission and in August 2021, the US Food and Drug Administration (FDA) already granted marketing authorization for JARDIANCE® (empagliflozin) as a treatment for adults with symptomatic chronic heart failure with reduced ejection fraction (systolic heart failure). The marketing authorization as a treatment for adults with heart failure with preserved ejection fraction was granted by the FDA in February 2022. “This is a breakthrough in cardiovascular medicine and brings hope for millions of patients suffering from heart failure with preserved ejection fraction,” said Jamal.

The drug may also have a beneficial effect further afield. Boehringer Ingelheim is now looking into whether it could have a positive impact on other chronic conditions. “Based on what we have seen so far for the SGLT2 inhibitor class, we are hopeful that empagliflozin will be beneficial in a broad range of chronic kidney disease patients studied in our EMPAKIDNEY trial and for the prevention of heart failure following a heart attack in our EMPACT-MI trial.” If the trials continue to be successful, empagliflozin could improve the lives of even more patients worldwide.

Heart Attack ≠
Heart Failure

A heart attack occurs suddenly and unexpectedly when the flow of blood to the heart is blocked. Damage to the heart muscle from a heart attack may lead to a state where the heart can no longer pump as well as it should and typically results in the death of part of a heart muscle. This raises the risk of heart failure. Heart failure is a condition in which the heart muscle no longer functions properly. It is progressive and can be fatal.

Heart failure with preserved ejection fraction (HFpEF)

The heart muscle contracts normally but the left ventricle is not able to relax meaning that the heart cannot properly fill with blood during ventricular filling.

Heart failure with reduced ejection fraction (HFrEF)

The left ventricle does not contract effectively, and less blood is pumped out to the body compared to a normally functioning heart.


of people with heart failure die within five years after diagnosis.

The heart is responsible for pumping the right amount of blood throughout the body. This is important because the blood carries oxygen and nutrients that our organs need to work properly.


people are expected to develop heart failure in their lifetime.