INS and type 2 diabetes mellitus: In postmenopause, estrogen decline reduces insulin sensitivity and increases metabolic dysfunction, correlating with higher arterial stiffness and systemic inflammation.134 Based on findings from the SUSTAIN and EMPA-REG OUTCOME studies,135,136 guidelines recommend for most women with T2DM: HbA1c <7%; and the use of drugs with proven cardiovascular benefit for secondary prevention, such as GLP-1 agonists (ex.: semaglutide) and sodium-glucose cotransporter type 2 (SGLT2) inhibitors (ex.: empagliflozin), which reduce cardiovascular events and hospitalizations due to HF.