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Key Points Question What is the contemporary pattern of evidence-based pharmacotherapy use among a real-world population of US patients with type 2 diabetes and atherosclerotic cardiovascular disease? Findings In this cohort study of 324 706 patients from health systems across the US, 58.6% of patients were receiving a statin (and a total of 26.8% of patients were receiving a high-intensity formation), 45.5% of patients were receiving an angiotensin-converting enzyme inhibitor or angiotensin-receptor blocker, 3.9% of patients were prescribed a glucagon-like peptide-1 receptor agonist, and 2.8% of patients were receiving a sodium glucose cotransporter-2 inhibitors. Meaning These findings suggest that multifaceted interventions are needed to overcome the large gaps in evidence-based pharmacotherapy use among this increasing population of patients at high risk of adverse outcomes.