Call to action: Understanding the differences in the use of SGLT-2 inhibitors and GLP-1 receptor agonists.


Cardiovascular disease remains one of the most prominent global health problems and has been demonstrated to disproportionally affect certain communities. Despite an increasing collective effort to improve health inequalities, a multitude of disparities continue to affect cardiovascular outcomes. Among the most prominent disparities within cardiovascular disease prevention are with the use and distribution of sodium-glucose cotransporter-2 (SGLT-2) inhibitors and glucagon-like peptide 1 (GLP-1) receptor agonists. Several landmark trials have demonstrated the efficacy of these novel agents, not only in cardiovascular disease prevention among those with diabetes, but also in heart failure and chronic kidney disease. However, the use of these agents remains limited by disparities in certain racial/ethnic, sex, and socioeconomic groups. This review works to highlight and understand these differences on the use and prescribing patterns of pivotal agents in cardiovascular disease prevention, SGLT-2 inhibitors and GLP-1 agonists. Our aim is to enrich understanding and to inspire efforts to end disparities in cardiovascular morbidity and mortality due to race, sex and income inequality.





Published Version (Please cite this version)


Publication Info

Khedagi, Apurva, Cara Hoke, Michelle Kelsey, Andrea Coviello, W Schuyler Jones, Larry R Jackson, Manesh R Patel, Rob W McGarrah, et al. (2023). Call to action: Understanding the differences in the use of SGLT-2 inhibitors and GLP-1 receptor agonists. American journal of preventive cardiology, 13. p. 100477. 10.1016/j.ajpc.2023.100477 Retrieved from

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Larry Ronald Jackson

Associate Professor of Medicine

Dr. Jackson is a physician-scientist with clinical expertise in adult clinical cardiac electrophysiology. His research focuses on identifying determinants of racial/ethnic differences in arrhythmia care and the development and implementation of patient-centered interventions aimed at facilitating shared decision-making in populations that have been systemically disadvantaged with abnormal heart rhythm conditions. Dr. Jackson has an advanced degree (MHSc) in clinical and qualitative research methodology and is a member of the Duke Clinical Research Institute. His research skills, obtained during his time at the Duke Clinical Research Institute Research Fellowship, include formal training in large database analysis, clinical trial operations, scientific writing, clinical trial adjudication and statistical analysis. Dr. Jackson’s research funding consists of two career development awards: 1) National Institute of Health/National Heart, Lung, and Blood Institute-K01 focused on racial and ethnic differences in oral anticoagulation use in patients with atrial fibrillation and 2) AHA career development award focused on analyzing racial and ethnic differences in the use of rhythm control strategies in patients with atrial fibrillation.  Dr. Jackson’s long-term, overarching goal as a physician-scientist is to decrease racial and ethnic disparities in arrhythmia care for patients with abnormal heart rhythm conditions.


Neha Pagidipati

Associate Professor of Medicine

Neha J. Pagidipati, MD, MPH, is an Assistant Professor of Medicine and cardiovascular disease prevention specialist.  Since 2011, she has conducted research on cardiometabolic disease prevention, lifestyle modification and weight management.  She is currently an NIH K12 scholar in Implementation and Dissemination Science. 

Dr. Pagidipati is building the Duke Cardiometabolic Disease Prevention Program, which focuses on behavior change and risk factor management in patients with high risk of cardiovascular and metabolic diseases such as diabetes and obesity.  The program’s multi-disciplinary team of cardiologists, endocrinologists, nephrologists, and hepatologists will work together to provide coordinated, team-based care to the most high-risk and complex patients in the health system. 

Dr. Pagidipati’s research grants include the COORDINATE-Diabetes Trial, to improve the quality of care for patients with diabetes and cardiovascular disease across the U.S., and QuBBD:  Deep Poisson Methods for Biomedical Time-to-Event and Longitudinal Data.  She served as a study clinician on the large, longitudinal EXSCEL (Exenatide Study of Cardiovascular Event Lowering) trial.  She is currently conducting a nation-wide study of obesity management using real-world data sources, and is a site investigator for the Baseline Health Study in collaboration with Verily Life Sciences. In addition, she is leading a large study within the Duke Health System to study heterogeneity within cardiovascular disease risk and response to weight loss interventions among individuals with obesity. 

Dr. Pagidipati graduated from Harvard College and Harvard Medical School.  She completed her internal medicine residency at Brigham and Women’s Hospital.  During a two-year research fellowship in Global Women’s Health at the Brigham, she obtained an MPH from the Harvard School of Public Health and studied cardiovascular disease prevention in women in India.  Dr. Pagidipati completed a four-year cardiology fellowship at the Duke University School of Medicine and served as Chief Research Fellow at the Duke Clinical Research Institute.  In 2017, she became a faculty member of the Duke University School of Medicine School. 


Nishant Shah

Assistant Professor of Medicine

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