A 58-year-old man with type 2 diabetes on metformin 1000 mg twice daily and sitagliptin has an HbA1c of 8.9%. He has established cardiovascular disease (prior MI 2 years ago) and an eGFR of 52 mL/min/1.73m². According to current ADA/ACC guidelines, which add-on agent provides the strongest evidence for cardiovascular mortality reduction in this patient?
- A Empagliflozin ✓
- B Alogliptin
- C Pioglitazone
- D Glimepiride
Correct answer: A. Empagliflozin
Explanation
In patients with type 2 diabetes and established cardiovascular disease, SGLT2 inhibitors like empagliflozin (EMPA-REG OUTCOME trial) reduce cardiovascular mortality, hospitalisation for heart failure, and progression of renal disease. At eGFR 52, empagliflozin remains effective and can be used. Alogliptin (EXAMINE trial) showed non-inferiority but no superiority for CV outcomes. Pioglitazone reduces stroke risk (PROactive trial) but increases fluid retention risk post-MI.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.