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Brooke Hudspeth, PharmD, CDE
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Antihyperglycemic Medications for Cardiovascular Disease Risk Reduction
Jennifer D. Goldman, PharmD, RPh, CDE, BC-ADM, FCCP
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Antihyperglycemic Medications for Cardiovascular Disease Risk Reduction

Jennifer D. Goldman, PharmD, RPh, CDE, BC-ADM, FCCP
Patients with T2D experience significant burdens to morbidity and mortality, with cardiovascular complications representing a substantial portion of this burden. Since 2008, the FDA has recommended that all novel antihyperglycemic agents undergo CVOTs to rule out any risk of contributing to cardiovascular events in these patients. While most agents undergoing CVOTs have achieved noninferiority, a few have shown superiority for cardiovascular events. These include the SGLT2 inhibitors empagliflozin and canagliflozin and the GLP-1 RAs liraglutide and semaglutide. Both empagliflozin and liraglutide have received an FDA-approved indication for reduction of cardiovascular events in patients with established CVD. Although these benefits exist, healthcare providers must individualize therapy for each patient, as many antihyperglycemic agents have black box warnings or tolerability issues. In addition to trials showing cardiovascular benefit (ie, SUSTAIN-6, LEADER, CANVAS, and EMPA-REG), several CVOTs are currently ongoing (eg, PIONEER, CREDENCE, DECLARE-TIMI, SCORED, VERTIS CV, CAROLINA, and CARMELINA) and results are expected in the next 1 to 2 years. It is important for healthcare providers to understand that many trials focus on showing a lack of harm rather than proving a benefit. Agents that have achieved noninferiority in CVOTs are recommended by clinical guidelines alongside beneficial agents and, oftentimes, other factors, such as risks for certain AEs, will dictate therapy selection. Healthcare providers must stay abreast of the potential benefits that these agents offer patients with T2D who are at high risk of cardiovascular events in order to optimize outcomes and reduce mortality

Author affiliation: Professor of Pharmacy Practice, School of Pharmacy–Boston MCPHS University, Boston, MA.
Funding source: This activity is supported by an educational grant from Boehringer Ingelheim Pharmaceuticals, Inc. and Lilly USA, LLC.
Author disclosure: Dr Goldman is a consultant for Becton Dickinson and serves on the speakers bureaus for Novo Nordisk and Sanofi.
Authorship information: Concept and design, acquisition of data, analysis and interpretation of data, drafting of the manuscript, and critical revision of the manuscript for important intellectual content.
Address correspondence to: jennifer.goldman@mcphs.edu.
Medical writing and editorial support provided by: Rachel L. Brown, PharmD, MPH.
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