A 42-year-old woman with type 2 diabetes on metformin 2g/day has HbA1c of 8.9%. Her eGFR is 52 mL/min/1.73m². She has established atherosclerotic cardiovascular disease. Which additional agent provides the strongest evidence for cardiovascular mortality reduction in this patient?
- A Sitagliptin
- B Pioglitazone
- C Glimepiride
- D Empagliflozin ✓
Correct answer: D. Empagliflozin
Explanation
Empagliflozin (SGLT2 inhibitor) demonstrated a 38% reduction in cardiovascular death in the EMPA-REG OUTCOME trial in patients with established ASCVD — the strongest CV mortality benefit among available antidiabetic agents. It is safe to use at eGFR ≥45 for cardiovascular protection even if glucose-lowering effect is reduced. Sitagliptin (TECOS) showed cardiovascular neutrality; pioglitazone increases heart failure risk; glimepiride has no proven CV benefit.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.