Which medication is recommended to best reduce CV risk in a woman with diabetes and an A1C of 8.4%?

Empagliflozin is recommended for women with diabetes and cardiovascular (CV) risk factors, particularly because it belongs to the sodium-glucose cotransporter-2 (SGLT2) inhibitor class. This class of medications has been shown to provide cardiovascular benefits beyond glucose control. Empagliflozin not only effectively lowers blood sugar levels but also offers advantages such as reducing the risk of major adverse cardiovascular events and improving heart failure outcomes.

The A1C of 8.4% indicates that the patient's diabetes is not optimally controlled, so there is a need for a medication that impacts both glycemic control and CV risk. Empagliflozin has shown significant evidence in clinical trials, such as the EMPA-REG OUTCOME trial, where it demonstrated a reduction in cardiovascular death among patients with type 2 diabetes and established cardiovascular disease.

Other options, while they may have glucose-lowering effects, do not have the same level of evidence supporting their cardiovascular benefits in patients with diabetes and established CV risks. Thus, empagliflozin is the most appropriate choice in this scenario.