A 50-year-old man with type 2 diabetes, known heart failure with reduced ejection fraction (HFrEF, EF 35%), and eGFR 55 is on metformin and insulin. Which additional agent has demonstrated mortality benefit specifically in HFrEF with diabetes in the EMPEROR-Reduced and DAPA-HF trials?
- A Empagliflozin or dapagliflozin (SGLT2 inhibitor) ✓
- B Saxagliptin
- C Alogliptin
- D Exenatide (GLP-1 agonist)
Correct answer: A. Empagliflozin or dapagliflozin (SGLT2 inhibitor)
Explanation
EMPEROR-Reduced (empagliflozin) and DAPA-HF (dapagliflozin) trials demonstrated significant reductions in cardiovascular death and worsening heart failure in HFrEF patients, including those without diabetes. SGLT2 inhibitors are now a pillar of HFrEF therapy regardless of diabetic status. DPP-4 inhibitors saxagliptin and alogliptin showed neutral or potentially harmful trends for heart failure hospitalization in the SAVOR-TIMI and EXAMINE trials.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.