1. Which study was designed to test for superiority and showed that patients using a GLP-1 RA gained a statistically superior cardiovascular benefit compared to patients using placebo?
A. ELIXA
B. EXSCEL
C. LEADER
D. SUSTAIN-6
E. Unsure
2. What is the correct cardiovascular FDA indication for liraglutide use in patients with type 2 diabetes already using metformin?
A. To reduce the risk of cardiovascular death in at-risk patients
B. To reduce the risk of hospitalization due to heart failure in patients using metformin
C. To reduce the risk of metformin-induced diarrhea
D. To reduce major adverse cardiovascular events in patients with established atherosclerotic cardiovascular disease
E. Unsure
3. Which of the following is NOT a proposed mechanism of action for the cardiovascular benefits exhibited by some of the GLP-1 RAs?
A. Anti-inflammatory effects
B. Atherosclerotic vascular benefits
C. Vasodilation
D. Intravascular volume contraction
E. Unsure
4. Why are pharmaceutical manufacturers of new antihyperglycemic agents used in adults with type 2 diabetes expected to complete cardiovascular outcome trials (CVOTs)?
A. To rule out the risk of drug interactions between the new antihyperglycemic medications and other commonly used medications.
B. To determine which new antihyperglycemic medications may further reduce the risk for major adverse cardiovascular events.
C. To prove that patients with type 2 diabetes receiving the new medication do not experience increased rates of cardiovascular events.
D. To verify that the new antihyperglycemic medication does not contribute to additional weight gain, since diabetes commonly coincides with metabolic syndrome.
E. Unsure
5. Which of the below could be a valid rationale to explain a neutral outcome of a GLP-1 RA cardiovascular outcome trial (CVOT) compared to placebo when a benefit actually exist?
A. Low drop-out or withdrawal rate in the placebo group
B. Low exposure to the study drug
C. Overpowered study to detect a statistical difference
D. Follow-up period too lengthy
E. Unsure
6. A colleague prescribed his first GLP-1 RA for a patient. He asked how soon the CV risk protection will be achieved after initiating therapy. Which statement below is the most correct reply regarding onset of CV benefits?
A. CV benefits are achieved after the medication has reached steady state.
B. CV benefits are achieved after 3 to 6 months of GLP-1 RA use.
C. CV benefits are achieved as glycemic targets are reached.
D. CV benefits are achieved after 12 to 18 months of GLP-1 RA use
E. Unsure
7. Your patient is a 66-year-old Caucasian female. She has had type 2 diabetes for 10 years and has a baseline A1C of 7.3%. She currently takes metformin 1000 mg po BID. Her past medical history is only significant for migraines and GERD. Which study population best represents your patient?
A. REWIND
B. PIONEER 6
C. LEADER
D. SUSTAIN 6
E. Unsure
8. Which answer best describes why the FDA does not require cardiovascular outcome trials (CVOTs) to be conducted on medications for treating type 1 diabetes?
A. Because insulin is required for sustaining life for those with type 1 diabetes.
B. Because patients with type 1 diabetes are not at an elevated cardiovascular risk.
C. Because insulin therapy is already known to increase cardiovascular risk.
D. This is incorrect. The FDA requires CVOTs be conducted on medications for treating any type of diabetes due to the overall increased cardiovascular risk present in all forms of diabetes.
E. Unsure
9. Which GLP-1 RA has received an FDA indication for reducing the risk of a cardiovascular endpoint based on findings from a completed CVOT?
A. Liraglutide daily subcutaneous injection
B. Exenatide BID subcutaneous injection
C. Exenatide weekly subcutaneous injection
D. Lixisenatide daily subcutaneous injection
E. Unsure
10. What is included in the typical primary composite major adverse cardiovascular event (MACE) outcome for GLP-1 RA cardiovascular outcome trials (CVOTs)?
A. Non-fatal myocardial infarction, non-fatal stroke, and cardiovascular death
B. All-cause mortality, non-fatal myocardial infarction, and non-fatal stroke
C. Non-fatal myocardial infarction, non-fatal stroke, and cardio revascularization
D. Unstable angina, heart failure exacerbation, and cardiovascular death
E. Unsure
Evaluation Questions
11. How confident are in your response regarding CV benefits with GLP-1 RAs?
A. Not at all confident
B. Somewhat confident
C. Confident
D. Highly confident