Effects of Empagliflozin and Dapagliflozin on Lipid Profiles and Atherogenic Risk Indices in Patients with Heart Failure and a History of CABG: First Evidence in the Literature

<b>Objective:</b> This study aimed to compare the effects of empagliflozin and dapagliflozin on classical lipid parameters-including total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglycerides (TG)-as well as on atherogenic risk indices, including the atherogenic index of plasma (AIP), Castelli Risk Index I (CRI-I), Castelli Risk Index II (CRI-II), atherogenic coefficient (AC), and triglyceride-glucose index (TyG), in patients with heart failure and a history of coronary artery bypass grafting (CABG). To our knowledge, this is the first study to comprehensively evaluate these parameters in this high-risk population. <b>Methods:</b> This single-center, retrospective study included 484 patients with preserved ejection fraction heart failure and prior CABG who were treated with sodium-glucose cotransporter-2 (SGLT2) inhibitors. Patients were allocated to empagliflozin (<i>n</i> = 201) or dapagliflozin (<i>n</i> = 283) groups. All patients were receiving statin therapy. Lipid parameters and atherogenic indices were evaluated at baseline and after 12 weeks of treatment. <b>Results:</b> Both empagliflozin and dapagliflozin significantly reduced TC and LDL-C at 12 weeks (<i>p</i> < 0.001). No significant changes were observed in HDL-C or TG. Both agents produced significant improvements in CRI-I, CRI-II, AC, and TyG index (all <i>p</i> < 0.001), while AIP remained unchanged. Dapagliflozin achieved a greater reduction in TC (<i>p</i> = 0.044). <b>Conclusions:</b> This study represents the first direct comparison of empagliflozin and dapagliflozin on lipid profiles and atherogenic indices in patients with heart failure and prior CABG. Both agents significantly improved TC, LDL-C, and atherogenic indices. Dapagliflozin achieved a greater reduction in TC compared with empagliflozin, but overall both drugs demonstrated favorable and largely comparable effects. Beyond improvements in absolute values, both agents also contributed to favorable shifts in risk categories of lipid-derived indices. These findings suggest that clinical decision-making between empagliflozin and dapagliflozin may rely on factors other than lipid modulation. Larger multicenter prospective trials are warranted to confirm these results and clarify their long-term cardiovascular implications.