Abstract / Summary
Glucagon-like peptide-1 receptor agonists (GLP-1RAs) and sodium-glucose cotransporter-2 inhibitors (SGLT2is) improve cardiovascular, kidney, and metabolic outcomes, but equitable access remains a major challenge. This review synthesizes U.S. evidence on disparities in their use and proposes an Equity-First Framework for cardiovascular-kidney-metabolic care to advance pharmacoequity.
Across 100 U.S.o studies published from 2013 to 2026, the most consistent inequities involved race and ethnicity, socioeconomic status, insurance coverage, age, and access to specialty care, while geographic and sex-related patterns were more heterogeneous. Black and Hispanic patients, Medicaid beneficiaries, lower-income populations, and older adults frequently experienced lower prescribing or initiation. Although use increased following landmark trials and guideline updates, uptake remained well below the eligible population, and disparities persisted or widened for some newer agents. Barriers spanned societal and policy, health-system, provider, patient, and therapy-related domains. Achieving pharmacoequity will require coordinated, multilevel implementation. Our framework links equity-relevant factors and implementation determinants to actionable strategies, including equity monitoring, identification and engagement of eligible patients, equitable care pathways, reduction of structural access barriers, and support for clinicians and patients.