Medications, Devices Available for Optimal Cardiovascular Health | APhA 2025
Heather Johnson, PharmD, BCACP, CTTS, and Heather Roth, BSPharm, RPh, discuss medications and devices used for improving cardiovascular health among patients with or without diabetes.
Both glucagon-like peptide-1 (GLP-1) and sodium-glucose cotransporter 2 (SGLT2) medications provide significant cardiovascular benefits, while continuous glucose monitoring (CGM) devices can be used in patients with or without insulin. However, according to a presentation at the American Pharmacists Association 2025 Annual Meeting and Exposition, these positive cardiovascular outcomes are best achieved when pharmacists educate and counsel the patients that use these products.1
In a session titled Moonshine vs Tennessee Wine: Debate on Controversies in Diabetes, Heather Johnson, PharmD, BCACP, CTTS, and Heather Roth, BSPharm, RPh, went head-to-head in a mock debate. In their first debate, they each highlighted the benefits of GLP-1s and SGLT2 medications, while their second debate focused on CGM use for patients with or without insulin.
SGLT2s, GLP-1s, and CGMs have all been used to improve CVD outcomes in patients with or without diabetes. | image credit: Harvinder / stock.adobe.com
Roth led the debate discussing the mechanisms of GLP-1s and how they are used to benefit patients.
READ MORE: CGM User, Device Errors Pharmacists Should Understand | APhA 2025
“I just like to point these different things out that occur when using a GLP-1, including increasing glucose dependent insulin secretion, decreasing that inappropriate glucagon secretion, flowing gastric emptying, and then also decreasing food intake, which leads to many things, including weight loss, which is not a surprise. [GLP-1s] also reduce blood pressure, cholesterol, and our blood glucose, leading to an A1c reduction,” she said.1
Roth mentioned the 4 categories patients may be placed in that explains their CVD risk, including patients with established atherosclerotic CVD (ASCVD), heart failure (HF), or chronic kidney disease (CKD). When it comes to the improvement of CVD outcomes, pharmacists are aware of the risk factors and medication options used to reduce risks.
But as Roth and Johnson demonstrated throughout their debate, there are different instances where GLP-1 benefits could outweigh those of SGLT2s and vice versa.
“We know, even without diabetes, patients benefit from being on an SGLT2. We now have quadruple therapy for guideline-directed medication therapy,” said Johnson.1 “With empagliflozin (Jardiance) and canagliflozin (Invokana) specifically, we have that superiority in the composite outcome of cardiovascular death, non-fatal [myocardial infarction], and non-fatal stroke. Here, this one’s really driven by that [reduction in] death.”
Johnson continued with her support of SGLT2s by explaining the benefits of this medication class, including HF reduction, compounded CVD benefits, improvement of preserved ejection fraction, cost-effectiveness, and more. Roth then made her rebuttal on the GLP-1 side, explaining their benefits in reducing stroke, improving weight, making adherence convenient, as well as research currently being conducted that is expected to show further CKD and CVD benefits.
They then pivoted to the use of CGMs in populations that are treated or not treated with insulin. But before exploring Roth and Johnson’s arguments, it’s important to understand the original intent of CGM and how it has evolved since.
“CGM systems were originally intended only for people with diabetes,” wrote authors of a study published in the Journal of Diabetes Science and Technology.2 “Recently, there has been interest in monitoring glucose concentrations in a variety of other situations. As data accumulate to support the use of CGM systems in additional states unrelated to diabetes, the use of CGM systems is likely to increase accordingly.”
Ultimately, both Roth and Johnson concluded their CGM debate agreeing with this sentiment. Roth’s key argument was that CGMs were designed for patients with diabetes being prescribed insulin. Johnson agreed, stating that her argument was weaker and there is little evidence that explains CGM benefits in patients without diabetes.
However, while CGMs may be best designed for use in patients with diabetes, the advances in health care technology could encourage CGM use in populations well beyond those with diabetes.
“The pace of development of diabetes technology is extremely rapid,” continued Roth.1 “These technologies are improving and they're getting lower-cost. Their access is increasing, and therefore, a lot of folks are going to be using them.”
With diabetes and CVD being such prominent diseases worldwide, new devices and medications like those that Roth and Johnson mentioned have made a significant impact on patient outcomes. However, with such rapid advancement in health care technology, pharmacists are encouraged to step in, properly educate their patients on these products, and know how to properly counsel their use.
“Both GLP-1s and SGLT2s are really beneficial for cardiovascular health in our patients, both with and without diabetes,” concluded Johnson.1 “Continuous glucose monitors may be beneficial for all patients, as long as we or someone else on their team is there to educate them about how to properly use it and properly use that data.”
