A 58-year-old man with type 2 diabetes (HbA1c 8.6%), established CKD stage 3b, and a myocardial infarction 18 months ago is reviewed for glycaemic optimisation. Which agent provides the strongest evidence for cardiovascular mortality reduction specifically in patients with CKD and established atherosclerotic cardiovascular disease simultaneously?
- A Liraglutide
- B Dulaglutide
- C Empagliflozin ✓
- D Semaglutide (oral)
Explanation
Empagliflozin (EMPA-REG OUTCOME) demonstrated significant reduction in cardiovascular death, heart failure hospitalisation, and renal endpoints including in patients with CKD, making it the preferred agent when both CKD and established ASCVD coexist. GLP-1 receptor agonists like liraglutide (LEADER), dulaglutide (REWIND), and semaglutide have strong cardiovascular outcome data but are second-line when eGFR is reduced (<45 mL/min/1.73m² for some agents) or when HF/CKD endpoints are prioritised. The ADA-EASD 2023 consensus places SGLT-2 inhibitors as first choice in this specific dual-indication scenario.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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