SGLT-2 inhibitors act in the proximal tubule to increase urinary excre- tion of glucose and sodium, leading to a reduction in HbA1c, body weight, and BP. Three RCTs have shown a significant reduction in ASCVD events and heart failure with use of an SGLT-2 inhibitor.S4.2-9,S4.2-10, Although most patients studied had estab- lished CVD at baseline, the reduction in heart failure has been shown to extend to primary prevention The GLP-1R agonists increase insulin and glucagon production in the liver, increase glucose uptake in muscle and adipose tissue, and decrease hepatic glucose production. Three GLP-1R agonists have been found to significantly reduce the risk of ASCVD in adults with T2DM who are at high As opposed to a reduc- tion in heart failure with SGLT-2 inhibitors, the ben- efit of the GLP-1R agonists has been a reduction in ASCVD events though the majority of patients stud- ied had established CVD. In patients with T2DM and additional risk fac- tors for CVD, it may be reasonable to initiate these 2 classes of medications for primary prevention of CVD. 4.3. Adults With High Blood Cholesterol Recommendations from the 2018 Cholesterol Clinical are included and adapted below. Recommendations for Adults With High Blood Cholesterol Referenced studies that support recommendations are summarized in Online Data Supplements 11 and 12. 