A 62-year-old man with type 2 diabetes and chronic kidney disease (eGFR 30 mL/min) develops heart failure. Which antidiabetic drug has the strongest evidence for cardiovascular mortality benefit AND is safe at this eGFR level?
- A Empagliflozin ✓
- B Metformin
- C Sitagliptin
- D Glimepiride
Correct answer: A. Empagliflozin
Explanation
SGLT2 inhibitors (empagliflozin, dapagliflozin, canagliflozin) have demonstrated cardiovascular mortality reduction in multiple large outcome trials (EMPA-REG OUTCOME, DAPA-HF, EMPEROR-Reduced). Empagliflozin is now approved down to eGFR ≥20 mL/min for heart failure benefit even though its glucose-lowering effect diminishes at lower eGFR. Metformin is contraindicated at eGFR <30 due to lactic acidosis risk. Sitagliptin is safe but has neutral CV outcome.
Reference: KD Tripathi, Essentials of Medical Pharmacology, 8th ed.
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Written and medically reviewed by the StethoPrep medical team.