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Antza C, Grassi G, Weber T, Persu A, Jordan J, Nilsson PM, Redon J, Stabouli S, Kreutz R, Kotsis V. Assessment and Management of Patients with Obesity and Hypertension in European Society of Hypertension Excellence Centres. A survey from the ESH Working Group on Diabetes and Metabolic Risk Factors. Blood Press 2024; 33:2317256. [PMID: 38407195 DOI: 10.1080/08037051.2024.2317256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 01/31/2024] [Indexed: 02/27/2024]
Abstract
BACKGROUND Healthcare providers are faced with an increasing number of patients with obesity and arterial hypertension. Preventing obesity-associated hypertension and appropriately managing patients with established disease are both important. Hence, the aim of our study was to evaluate the clinical care of patients with obesity and hypertension among ESH Excellence Centres (ECs). METHODS We conducted a cross-sectional, international 30-item survey through e-mails. RESULTS In total, 70 representatives of ECs participated (78% men) with 66% of them practicing medicine for more than 30 years and working in well-equipped clinics. Most were internists (41%) and cardiologists (37%) and 73% reported training on the management of obese patients with hypertension. A majority weigh their patients (77%) and evaluate patients for sleep disorders (93%). However, only 47% spend more than 5min to advise for lifestyle modification in general, 59% for weight loss, 56% for salt intake and 64% for exercise. Finally, a minority of participants ask patients if they like their body (6%) or about previous attempts to lose weight (28%), evaluate 24h urinary sodium excretion rate (22%) and provide written (15%) or personalized (10%) dietary advices. If the patient suffers also from type 2 diabetes mellitus, 66% switch treatment to GLP1 receptor agonists and 60% to SGLT2 inhibitors. CONCLUSION Most clinicians in ESH ECs are well educated regarding obesity-associated hypertension, and clinics are sufficiently equipped to manage these patients, as well. However, several deficits were reported regarding efforts to address and implement obesity specific aspects and interventions to improve care in patients with obesity and hypertension.
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Affiliation(s)
- Christina Antza
- 3rd Department of Internal Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Guido Grassi
- Clinical Medica, School of Medicine and Surgery, Milano-Bicocca University
| | - Thomas Weber
- Cardiology Department, Klinikum Wels-Grieskirchen, Wels, Austria
| | - Alexandre Persu
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires Saint-Luc and Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - Jens Jordan
- Institute of Aerospace Medicine, German Aerospace Center, Medical Faculty, University of Cologne, Cologne, Germany
- University Hypertension Center, Cologne, Germany
| | - Peter M Nilsson
- Department of Clinical Sciences, Internal Medicine, Skåne University Hospital, Malmö, Sweden
| | - Josep Redon
- Cardiometabolic Renal Risk Research Group, INCLIVA Biomedical Research Institute, University of Valencia, Valencia, Spain
- CIBEROBN, ISCIII, Madrid, Spain
| | - Stella Stabouli
- 1st Department of Pediatrics, Aristotle University of Thessaloniki, Hippokratio General Hospital, Thessaloniki, Greece
| | - Reinhold Kreutz
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin. - Institute of Clinical Pharmacology and Toxicology, Berlin, Germany
| | - Vasilios Kotsis
- Clinical Medica, School of Medicine and Surgery, Milano-Bicocca University
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2
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Timóteo AT, Barbas Albuquerque F, Lacerda Teixeira B. Pericardium, epicardial adipose tissue, and heart failure with preserved ejection fraction: Pathophysiology, quantification and treatment target. Int J Cardiol 2024; 412:132303. [PMID: 38944349 DOI: 10.1016/j.ijcard.2024.132303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 05/15/2024] [Accepted: 06/26/2024] [Indexed: 07/01/2024]
Abstract
Heart failure is an important cause of mortality and morbidity worldwide. Heart failure with preserved ejection fraction (HFpEF) incidence and prevalence is increasing, and the phenotype associated with obesity is the most frequent. Epicardial adipose tissue (EAT) is directly associated with systemic obesity and several previous studies have shown a clear link between EAT and HFpEF. Moreover, the restriction induced by the pericardium is also linked to HFpEF. In this review we will describe the epidemiological association between the pericardium, EAT and HFpEF, how to quantify EAT, what are the pathophysiological mechanism to explain theses association and how can the pericardium and EAT be a treatment target in patients with HFpEF.
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Affiliation(s)
- Ana Teresa Timóteo
- Cardiology Department, Santa Marta Hospital, Unidade Local de Saúde São José, Lisbon, Portugal; NOVA Medical School, NOVA Lisbon University, Portugal.
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Pham MHX, Christensen DM, Kristensen AT, Middelfart C, Sindet-Pedersen C, Gislason G, Olsen NT. Association of overweight and obesity with coronary risk factors and the presence of multivessel disease in patients with obstructive coronary artery disease - A nationwide registry study. INTERNATIONAL JOURNAL OF CARDIOLOGY. CARDIOVASCULAR RISK AND PREVENTION 2024; 22:200299. [PMID: 38983607 PMCID: PMC11231706 DOI: 10.1016/j.ijcrp.2024.200299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 05/22/2024] [Accepted: 06/13/2024] [Indexed: 07/11/2024]
Abstract
Background The growing prevalence of obesity is expected to increase the burden of coronary artery disease. This study examined the prevalence of overweight and obesity in patients with a first-time diagnosis of obstructive coronary artery disease in a contemporary population. The association of body-mass-index (BMI) with age, traditional risk factors, and the presence of multivessel disease were explored. Methods and results Using the Danish Nationwide registries, we identified 49,733 patients with a first-time diagnosis of obstructive coronary artery disease in the period 2012-2018. We investigated the association between BMI and coronary risk factors by multivariate logistic regression. Mean age was 65.8 ± 11.8 years, mean BMI was 27.5 kg/m2 ± 7.2, and 73.2 % were men. 66.3 % had a BMI ≥25 kg/m2 and 1.3 % were underweight. The prevalence of patients with BMI ≥25 kg/m2 decreased with increasing age and was 69 % in patients <50 year vs. 46.2 % in patients ≥80 years (p < 0.001). In all age groups, higher odds of BMI ≥25 kg/m2 were observed in males, former smokers, and patients with hypertension. In multivariate logistic regression, BMI ≥25 kg/m2 was not associated with presence of multivessel disease (p = 0.74). Conclusion In this large, nationwide study, 66.3 % of patients with first time diagnosis of obstructive coronary disease had BMI ≥25 kg/m2. Young patients had higher BMI and were more likely to be current smokers. Overweight or obesity was independently associated with the presence of diabetes and hypertension. BMI ≥25 kg/m2 was not independently associated with the presence of multivessel disease.
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Affiliation(s)
- Maria Hang Xuan Pham
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark
| | - Daniel Mølager Christensen
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark
- Department of Cardiology, Zealand University Hospital, Roskilde, Denmark
| | - Andreas Torp Kristensen
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark
| | - Charlotte Middelfart
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark
| | - Caroline Sindet-Pedersen
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark
- The Danish Heart Foundation, Copenhagen, Denmark
| | - Gunnar Gislason
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark
- The Danish Heart Foundation, Copenhagen, Denmark
| | - Niels Thue Olsen
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark
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4
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Ansari S, Khoo B, Tan T. Targeting the incretin system in obesity and type 2 diabetes mellitus. Nat Rev Endocrinol 2024; 20:447-459. [PMID: 38632474 DOI: 10.1038/s41574-024-00979-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/12/2024] [Indexed: 04/19/2024]
Abstract
Obesity and type 2 diabetes mellitus (T2DM) are widespread, non-communicable diseases that are responsible for considerable levels of morbidity and mortality globally, primarily in the form of cardiovascular disease (CVD). Changes to lifestyle and behaviour have insufficient long-term efficacy in most patients with these diseases; metabolic surgery, although effective, is not practically deliverable on the scale that is required. Over the past two decades, therapies based on incretin hormones, spearheaded by glucagon-like peptide 1 (GLP1) receptor agonists (GLP1RAs), have become the treatment of choice for obesity and T2DM, and clinical evidence now suggests that these agents have benefits for CVD. We review the latest advances in incretin-based pharmacotherapy. These include 'GLP1 plus' agents, which combine the known advantages of GLP1RAs with the activity of additional hormones, such as glucose-dependent insulinotropic peptide, glucagon and amylin, to achieve desired therapeutic goals. Second-generation non-peptidic oral GLP1RAs promise to extend the benefits of GLP1 therapy to those who do not want, or cannot have, subcutaneous injection therapy. We conclude with a discussion of the knowledge gaps that must be addressed before incretin-based therapies can be properly deployed for maximum benefit in the treatment of obesity and T2DM.
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Affiliation(s)
- Saleem Ansari
- Division of Diabetes, Endocrinology and Metabolism, Imperial College London, London, UK
| | - Bernard Khoo
- Department of Endocrinology, Division of Medicine, Royal Free Campus, University College London, London, UK
| | - Tricia Tan
- Division of Diabetes, Endocrinology and Metabolism, Imperial College London, London, UK.
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5
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Sundbom M, Järvholm K, Sjögren L, Nowicka P, Lagerros YT. Obesity treatment in adolescents and adults in the era of personalized medicine. J Intern Med 2024; 296:139-155. [PMID: 39007440 DOI: 10.1111/joim.13816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/16/2024]
Abstract
In this multi-professional review, we will provide the in-depth knowledge required to work in the expanding field of obesity treatment. The prevalence of obesity has doubled in adults and quadrupled in children over the last three decades. The most common treatment offered has been lifestyle treatment, which has a modest or little long-term effect. Recently, several new treatment options-leading to improved weight loss-have become available. However, long-term care is not only about weight loss but also aims to improve health and wellbeing overall. In the era of personalized medicine, we have an obligation to tailor the treatment in close dialogue with our patients. The main focus of this review is new pharmacological treatments and modern metabolic surgery, with practical guidance on what to consider when selecting and guiding the patients and what to include in the follow-up care. Furthermore, we discuss common clinical challenges, such as patients with concurrent eating disorder or mental health problems, and treatment in the older adults. We also provide recommendations on how to deal with obesity in a non-stigmatizing way to diminish weight stigma during treatment. Finally, we present six microcases-obesity treatment for persons with neuropsychiatric disorders and/or intellectual disability; obesity treatment in the nonresponsive patient who has "tried everything"; and hypoglycemia, abdominal pain, and weight regain after metabolic surgery-to highlight common problems in weight-loss treatment and provide personalized treatment suggestions.
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Affiliation(s)
- Magnus Sundbom
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
- Department of Surgery, University Hospital, Uppsala, Sweden
| | - Kajsa Järvholm
- Department of Psychology, Lund University, Lund, Sweden
- Childhood Obesity Unit, Skåne University Hospital, Malmö, Sweden
| | - Lovisa Sjögren
- Department of Pediatrics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Pediatrics, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Paulina Nowicka
- Department of Food Studies, Nutrition and Dietetics, Uppsala University, Uppsala, Sweden
| | - Ylva Trolle Lagerros
- Department of Medicine (Solna), Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden
- Center for Obesity, Academic Specialist Center, Stockholm Health Services, Stockholm, Sweden
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6
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Bozkurt B. Contemporary pharmacological treatment and management of heart failure. Nat Rev Cardiol 2024; 21:545-555. [PMID: 38532020 DOI: 10.1038/s41569-024-00997-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/07/2024] [Indexed: 03/28/2024]
Abstract
The prevention and treatment strategies for heart failure (HF) have evolved in the past two decades. The stages of HF have been redefined, with recognition of the pre-HF state, which encompasses asymptomatic patients who have developed either structural or functional cardiac abnormalities or have elevated plasma levels of natriuretic peptides or cardiac troponin. The first-line treatment of patients with HF with reduced ejection fraction includes foundational therapies with angiotensin receptor-neprilysin inhibitors, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, β-blockers, mineralocorticoid receptor antagonists, sodium-glucose cotransporter 2 (SGLT2) inhibitors and diuretics. The first-line treatment of patients with HF with mildly reduced ejection fraction or with HF with preserved ejection fraction includes SGLT2 inhibitors and diuretics. The timely initiation of these disease-modifying therapies and the optimization of treatment are crucial in all patients with HF. Reassessment after initiation of these therapies is recommended to evaluate patient symptoms, health status and left ventricular function, and timely referral to a HF specialist is necessary if a patient has persistent advanced HF symptoms or worsening HF. Lifestyle modification and treatment of comorbidities such as diabetes mellitus, ischaemic heart disease and atrial fibrillation are crucial through each stage of HF. This Review provides an overview of the management strategies for HF according to disease stages that are derived from the recommendations in the latest US and European HF guidelines.
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Affiliation(s)
- Biykem Bozkurt
- Winters Center for Heart Failure Research, Cardiovascular Research Institute, Baylor College of Medicine, Houston, TX, USA.
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7
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Arena R, Pronk NP, Lavie CJ. The tip of the iceberg: Will GLP-1 receptor agonists unintentionally contribute to titanic cardiovascular events in certain individuals? Curr Probl Cardiol 2024; 49:102676. [PMID: 38795802 DOI: 10.1016/j.cpcardiol.2024.102676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Accepted: 05/22/2024] [Indexed: 05/28/2024]
Affiliation(s)
- Ross Arena
- Department of Physical Therapy, College of Applied Science, University of Illinois, Chicago, IL, USA; Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL, USA.
| | - Nicolaas P Pronk
- Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL, USA; HealthPartners Institute, Minneapolis, MN, USA; Department of Health Policy and Management, University of Minnesota, Minneapolis, MN, USA
| | - Carl J Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School and The University of Queensland School of Medicine, New Orleans, LA, USA
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8
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Nguyen A, Smith E, Hashemy H, Agarwal SM, Hahn MK, Paterson AD, Dash S. Glucagon-like-peptide 1 receptor agonism and attempted suicide: A Mendelian randomisation study to assess a potential causal association. Clin Obes 2024; 14:e12676. [PMID: 38778795 DOI: 10.1111/cob.12676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 04/25/2024] [Accepted: 05/05/2024] [Indexed: 05/25/2024]
Abstract
Glucagon-like-peptide 1 receptor agonists (GLP-1RA) have transformed type 2 diabetes (T2D) and obesity management. Multiple regulatory agencies are investigating reported associations between GLP1-RA and increased suicide attempts (SA), but observational data may be prone to confounding. Randomised control trials (RCT) of GLP-1RA were largely undertaken in people at lower risk of SA. Real-world data suggest semaglutide use associates with reduced suicidal ideation and depression but was under-powered to statistically assess risk of SA. Mendelian randomisation (MR) leverages genetic instrument(s) to infer potential causal association between an exposure and an outcome. We undertook MR using missense variants in the gene encoding GLP1R that improve glycemia, lower T2D risk and/or lower BMI, to investigate potential causal association between GLP-1RA and SA. In people of European ancestry, MR did not find evidence genetically proxied GLP1RA increased SA in a general population cohort: (rs10305492, exposure: HbA1c, odds ratio [OR] and 95% confidence interval [CI]: 1.38, 0.41-4.62, p = .60), (rs10305492, exposure: FG, OR 1.27, 0.52-3.13, p = .60) and (rs1042044, exposure BMI, OR 0.30, 0.06-1.48) with concordant results in a multi-ancestry SA case-control cohort. In conclusion, we did not find MR evidence that increased GLP-1RA impacts SA. This awaits confirmation with RCT and real-world data.
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Affiliation(s)
- Anthony Nguyen
- Department of Medicine, University Health Network, Toronto, Toronto, Canada
| | - Emily Smith
- Centre for Addiction and Mental Health (CAMH), Toronto, Institute of Medical Science, Department of Psychiatry & Pharmacology, Banting and Best Diabetes Centre (BBDC), University of Toronto, Toronto, Canada
| | - Habiba Hashemy
- Department of Medicine, University Health Network, Toronto, Toronto, Canada
| | - Sri Mahavir Agarwal
- Centre for Addiction and Mental Health (CAMH), Toronto, Institute of Medical Science, Department of Psychiatry & Pharmacology, Banting and Best Diabetes Centre (BBDC), University of Toronto, Toronto, Canada
| | - Margaret K Hahn
- Centre for Addiction and Mental Health (CAMH), Toronto, Institute of Medical Science, Department of Psychiatry & Pharmacology, Banting and Best Diabetes Centre (BBDC), University of Toronto, Toronto, Canada
| | - Andrew D Paterson
- Genetics and Genome Biology Program, The Hospital for Sick Children, Toronto, Canada
- Divisions of Epidemiology and Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Satya Dash
- Department of Medicine, University Health Network, Toronto, Toronto, Canada
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Jones KL, Marathe CS, Wu T, Rayner CK, Nauck M, Horowitz M. Getting the measure of the pressure: Optimal assessment of the effects of glucagon-like peptide-1 receptor agonists on blood pressure. Diabetes Obes Metab 2024; 26:3003-3005. [PMID: 38706104 DOI: 10.1111/dom.15631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Revised: 04/15/2024] [Accepted: 04/15/2024] [Indexed: 05/07/2024]
Affiliation(s)
- Karen L Jones
- Adelaide Medical School, University of Adelaide, Adelaide, Australia
- Centre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide, Australia
- Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide, Australia
| | - Chinmay S Marathe
- Adelaide Medical School, University of Adelaide, Adelaide, Australia
- Centre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide, Australia
- Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide, Australia
| | - Tongzhi Wu
- Adelaide Medical School, University of Adelaide, Adelaide, Australia
- Centre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide, Australia
| | - Christopher K Rayner
- Adelaide Medical School, University of Adelaide, Adelaide, Australia
- Centre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide, Australia
- Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, Australia
| | | | - Michael Horowitz
- Adelaide Medical School, University of Adelaide, Adelaide, Australia
- Centre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide, Australia
- Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide, Australia
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Hayat J, Shah NP, Agarwala A, Khan MS, Butler J. GLP-1 Receptor Agonists and Cardiovascular Disease: What Do Clinicians Need to Know? Curr Atheroscler Rep 2024; 26:341-351. [PMID: 38809399 DOI: 10.1007/s11883-024-01214-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2024] [Indexed: 05/30/2024]
Abstract
PURPOSE OF REVIEW Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are gaining importance due to their effects on cardiovascular parameters. This review discusses the findings of dedicated cardiovascular outcome trials of GLP-1RAs and summarizes their utility to help clinicians understand their role in cardiovascular disease. RECENT FINDINGS Patients with diabetes mellitus are at an increased risk of cardiovascular disease. Cardiovascular outcome trials have shown GLP-1RAs decrease the primary composite outcome of the first occurrence of major adverse cardiovascular events (MACE) in patients with diabetes. Additionally, select GLP-1RAs have also shown improved cardiovascular outcomes in patients without diabetes who are either overweight (BMI ≥ 27), or obese (BMI ≥ 30). There have also been encouraging results in patients with heart failure with preserved ejection fraction. There is increasing evidence showing GLP-1RAs are beneficial across the cardiometabolic spectrum of disease. Implementation of these therapeutics into clinical practice is important to improve cardiovascular risk.
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Affiliation(s)
- Javeria Hayat
- Department of Internal Medicine, Corewell Health/Michigan State University, 100 Michigan St NE, Grand Rapids, MI, 49503, USA
| | - Nishant P Shah
- Division of Cardiology, Department of Medicine, Duke University School of Medicine, 2301 Erwin Road, Durham, NC, 27710, USA
| | - Anandita Agarwala
- Center for Cardiovascular Disease Prevention, Division of Cardiovascular Medicine, Baylor Scott and White the Heart Hospital, 1100 Allied Drive, Plano, TX, 75093, USA
| | - Muhammad Shahzeb Khan
- Division of Cardiology, Department of Medicine, Duke University School of Medicine, 2301 Erwin Road, Durham, NC, 27710, USA
| | - Javed Butler
- Baylor Scott and White Research Institute, 3434 Live Oak St Ste 501, Dallas, TX, 75204, USA.
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, 39213, USA.
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11
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Bensignor MO, Arslanian S, Vajravelu ME. Semaglutide for management of obesity in adolescents: efficacy, safety, and considerations for clinical practice. Curr Opin Pediatr 2024; 36:449-455. [PMID: 38774967 PMCID: PMC11222026 DOI: 10.1097/mop.0000000000001365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/04/2024]
Abstract
PURPOSE OF REVIEW The purpose of this review is to describe the existing limited data related to the use of semaglutide in adolescents with obesity, supplementing with findings from adult studies of semaglutide use. RECENT FINDINGS Semaglutide, as a once weekly subcutaneous injection for weight management, effectively reduces body mass index (BMI) while improving hyperglycemia, elevated alanine aminotransferase levels, hyperlipidemia, and quality of life in youth with obesity. As of this review, only one large randomized clinical trial of semaglutide in youth has been completed, with a follow-up duration of 68 weeks. Thus, long-term data on the safety in adolescents is limited, particularly regarding the risks of cholelithiasis, pancreatitis, suicidal ideation, and disordered eating. Due to the cost of semaglutide, particularly in the United States, limited cost effectiveness analyses have demonstrated unfavorable incremental cost-effectiveness ratios for semaglutide relative to phentermine-topiramate as an alternative antiobesity medication in adolescents. SUMMARY Semaglutide represents an important advance in the pediatric obesity management, with clear short-term reductions in BMI and improvement in metabolic parameters. However, its long-term safety and efficacy for youth with obesity remain to be demonstrated. Additional research is needed to assess trends in utilization and adherence to minimize the risk of worsening socioeconomic disparities in pediatric obesity.
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Affiliation(s)
- Megan O Bensignor
- Division of Pediatric Endocrinology and Diabetes, Center for Pediatric Obesity Medicine, University of Minnesota Medical School, Minneapolis, Minnesota; Division of Pediatric Endocrinology and Diabetes, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Silva Arslanian
- Division of Pediatric Endocrinology, Diabetes, and Metabolism and Center for Pediatric Research in Obesity and Metabolism, UPMC Children's Hospital of Pittsburgh and University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Mary Ellen Vajravelu
- Division of Pediatric Endocrinology, Diabetes, and Metabolism and Center for Pediatric Research in Obesity and Metabolism, UPMC Children's Hospital of Pittsburgh and University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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Barkas F, Sener YZ, Golforoush PA, Kheirkhah A, Rodriguez-Sanchez E, Novak J, Apellaniz-Ruiz M, Akyea RK, Bianconi V, Ceasovschih A, Chee YJ, Cherska M, Chora JR, D'Oria M, Demikhova N, Kocyigit Burunkaya D, Rimbert A, Macchi C, Rathod K, Roth L, Sukhorukov V, Stoica S, Scicali R, Storozhenko T, Uzokov J, Lupo MG, van der Vorst EPC, Porsch F. Advancements in risk stratification and management strategies in primary cardiovascular prevention. Atherosclerosis 2024; 395:117579. [PMID: 38824844 DOI: 10.1016/j.atherosclerosis.2024.117579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 04/29/2024] [Accepted: 05/14/2024] [Indexed: 06/04/2024]
Abstract
Atherosclerotic cardiovascular disease (ASCVD) remains a leading cause of morbidity and mortality worldwide, highlighting the urgent need for advancements in risk assessment and management strategies. Although significant progress has been made recently, identifying and managing apparently healthy individuals at a higher risk of developing atherosclerosis and those with subclinical atherosclerosis still poses significant challenges. Traditional risk assessment tools have limitations in accurately predicting future events and fail to encompass the complexity of the atherosclerosis trajectory. In this review, we describe novel approaches in biomarkers, genetics, advanced imaging techniques, and artificial intelligence that have emerged to address this gap. Moreover, polygenic risk scores and imaging modalities such as coronary artery calcium scoring, and coronary computed tomography angiography offer promising avenues for enhancing primary cardiovascular risk stratification and personalised intervention strategies. On the other hand, interventions aiming against atherosclerosis development or promoting plaque regression have gained attention in primary ASCVD prevention. Therefore, the potential role of drugs like statins, ezetimibe, proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, omega-3 fatty acids, antihypertensive agents, as well as glucose-lowering and anti-inflammatory drugs are also discussed. Since findings regarding the efficacy of these interventions vary, further research is still required to elucidate their mechanisms of action, optimize treatment regimens, and determine their long-term effects on ASCVD outcomes. In conclusion, advancements in strategies addressing atherosclerosis prevention and plaque regression present promising avenues for enhancing primary ASCVD prevention through personalised approaches tailored to individual risk profiles. Nevertheless, ongoing research efforts are imperative to refine these strategies further and maximise their effectiveness in safeguarding cardiovascular health.
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Affiliation(s)
- Fotios Barkas
- Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece.
| | - Yusuf Ziya Sener
- Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | | | - Azin Kheirkhah
- Institute of Genetic Epidemiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Elena Rodriguez-Sanchez
- Division of Cardiology, Department of Medicine, Department of Physiology, and Molecular Biology Institute, UCLA, Los Angeles, CA, USA
| | - Jan Novak
- 2(nd) Department of Internal Medicine, St. Anne's University Hospital in Brno and Faculty of Medicine of Masaryk University, Brno, Czech Republic; Department of Physiology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Maria Apellaniz-Ruiz
- Genomics Medicine Unit, Navarra Institute for Health Research - IdiSNA, Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), Pamplona, Spain
| | - Ralph Kwame Akyea
- Centre for Academic Primary Care, School of Medicine, University of Nottingham, United Kingdom
| | - Vanessa Bianconi
- Department of Medicine and Surgery, University of Perugia, Italy
| | - Alexandr Ceasovschih
- Internal Medicine Department, Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania
| | - Ying Jie Chee
- Department of Endocrinology, Tan Tock Seng Hospital, Singapore
| | - Mariia Cherska
- Cardiology Department, Institute of Endocrinology and Metabolism, Kyiv, Ukraine
| | - Joana Rita Chora
- Unidade I&D, Grupo de Investigação Cardiovascular, Departamento de Promoção da Saúde e Doenças Não Transmissíveis, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisboa, Portugal; Universidade de Lisboa, Faculdade de Ciências, BioISI - Biosystems & Integrative Sciences Institute, Lisboa, Portugal
| | - Mario D'Oria
- Division of Vascular and Endovascular Surgery, Department of Medical Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Nadiia Demikhova
- Sumy State University, Sumy, Ukraine; Tallinn University of Technology, Tallinn, Estonia
| | | | - Antoine Rimbert
- Nantes Université, CNRS, INSERM, l'institut du Thorax, Nantes, France
| | - Chiara Macchi
- Department of Pharmacological and Biomolecular Sciences "Rodolfo Paoletti", Università Degli Studi di Milano, Milan, Italy
| | - Krishnaraj Rathod
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom; Barts Interventional Group, Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
| | - Lynn Roth
- Laboratory of Physiopharmacology, University of Antwerp, Antwerp, Belgium
| | - Vasily Sukhorukov
- Laboratory of Cellular and Molecular Pathology of Cardiovascular System, Petrovsky National Research Centre of Surgery, Moscow, Russia
| | - Svetlana Stoica
- "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania; Institute of Cardiovascular Diseases Timisoara, Timisoara, Romania
| | - Roberto Scicali
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Tatyana Storozhenko
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium; Department of Prevention and Treatment of Emergency Conditions, L.T. Malaya Therapy National Institute NAMSU, Kharkiv, Ukraine
| | - Jamol Uzokov
- Republican Specialized Scientific Practical Medical Center of Therapy and Medical Rehabilitation, Tashkent, Uzbekistan
| | | | - Emiel P C van der Vorst
- Institute for Molecular Cardiovascular Research (IMCAR), RWTH Aachen University, 52074, Aachen, Germany; Aachen-Maastricht Institute for CardioRenal Disease (AMICARE), RWTH Aachen University, 52074, Aachen, Germany; Institute for Cardiovascular Prevention (IPEK), Ludwig-Maximilians-University Munich, 80336, Munich, Germany; Interdisciplinary Center for Clinical Research (IZKF), RWTH Aachen University, 52074, Aachen, Germany
| | - Florentina Porsch
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
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13
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Kaplan LM, Apovian CM, Ard JD, Allison DB, Aronne LJ, Batterham RL, Busetto L, Dicker D, Horn DB, Kelly AS, Mechanick JI, Purnell JQ, Ramos‐Salas X. Assessing the state of obesity care: Quality, access, guidelines, and standards. Obes Sci Pract 2024; 10:e765. [PMID: 39026558 PMCID: PMC11255038 DOI: 10.1002/osp4.765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 04/18/2024] [Accepted: 05/13/2024] [Indexed: 07/20/2024] Open
Abstract
Background An international panel of obesity medicine experts from multiple professional organizations examined patterns of obesity care and current obesity treatment guidelines to identify areas requiring updating in response to emerging science and clinical evidence. Aims The panel focused on multiple medical health and societal issues influencing effective treatment of obesity and identified several unmet needs in the definition, assessment, and care of obesity. Methods The panel was held in Leesburg, Virginia in September 2019. Results The panelists recommended addressing these unmet needs in obesity medicine through research, education, evaluation of delivery and payment of care, and updating clinical practice guidelines (CPG) to better reflect obesity's pathophysiological basis and heterogeneity, as well as the disease's health, sociocultural, and economic complications; effects on quality of life; need for standards for quantitative comparison of treatment benefits, risks, and costs; and the need to more effectively integrate obesity treatment guidelines into routine clinical practice and to facilitate more direct clinician participation to improve public understanding of obesity as a disease with a pathophysiological basis. The panel also recommended that professional organizations working to improve the care of people with obesity collaborate via a working group to develop an updated, patient-focused, comprehensive CPG establishing standards of care, addressing identified needs, and providing for routine, periodic review and updating. Conclusions Unmet needs in the definition, assessment and treatment of obesity were identified and a blueprint to address these needs developed via a clinical practice guideline that can be utilized worldwide to respond to the increasing prevalence of obesity.
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Affiliation(s)
- Lee M. Kaplan
- Obesity, Metabolism and Nutrition InstituteMassachusetts General Hospital and Harvard Medical SchoolBostonMassachusettsUSA
| | - Caroline M. Apovian
- Division of Endocrinology, Diabetes, Nutrition and Weight ManagementNutrition and Weight Management CenterBoston Medical Center and Boston University School of MedicineBostonMassachusettsUSA
| | - Jamy D. Ard
- Department of Epidemiology and PreventionWake Forest University School of MedicineWinston‐SalemNorth CarolinaUSA
| | - David B. Allison
- Department of Epidemiology and BiostatisticsIndiana University School of Public Health‐BloomingtonBloomingtonIndianaUSA
| | - Louis J. Aronne
- Department of MedicineWeill‐Cornell College of MedicineNew YorkNew YorkUSA
| | - Rachel L. Batterham
- Department of MedicineCentre for Obesity ResearchRayne InstituteUniversity College LondonLondonUK
- National Institute for Health and Care ResearchUniversity College London Hospitals Biomedical Research CentreLondonUK
| | - Luca Busetto
- Department of MedicineUniversity of PadovaPadovaItaly
| | - Dror Dicker
- Department of Internal Medicine DHaharon Hospital Rabin Medical CenterSackler School of MedicineTel Aviv UniversityTel AvivIsrael
| | - Deborah B. Horn
- Center for Obesity Medicine and Metabolic PerformanceUniversity of Texas McGovern Medical SchoolHoustonTexasUSA
| | - Aaron S. Kelly
- Department of Pediatrics and Center for Pediatric Obesity MedicineUniversity of MinnesotaMinneapolisMinnesotaUSA
| | - Jeffrey I. Mechanick
- Marie‐Josée and Henry R. Kravis Center for Cardiovascular Health at Mount Sinai HeartNew YorkNew YorkUSA
- Metabolic SupportDivision of Endocrinology, Diabetes and Bone DiseaseIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Jonathan Q. Purnell
- Division of Endocrinology, Diabetes, and Clinical NutritionKnight Cardiovascular InstituteOregon Health & Science UniversityPortlandOregonUSA
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14
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Trevella P, Ekinci EI, MacIsaac RJ. Potential kidney protective effects of glucagon-like peptide-1 receptor agonists. Nephrology (Carlton) 2024; 29:457-469. [PMID: 39030739 DOI: 10.1111/nep.14336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Revised: 05/08/2024] [Accepted: 06/09/2024] [Indexed: 07/22/2024]
Abstract
Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have gained increasing attention for their potential benefits in people with type 2 diabetes (T2DM) with chronic kidney disease (CKD). This class of medication has demonstrated promising results in reducing albuminuria, preserving estimated glomerular filtration rate (eGFR), and mitigating cardiovascular (CV) risk, making them potential therapeutic options for individuals with CKD. The kidney protective effects of GLP-1RAs extend beyond glycaemic control, and are thought to be attributed to their anti-inflammatory, antioxidant, and natriuretic properties. Despite these promising findings, the use of GLP-RAs has yet to be definitively shown to slow progression to chronic kidney failure, or reduce CV and kidney related death in people with T2DM and CKD. The Research Study to See How Semaglutide (a once weekly subcutaneous administered GLP-1RA) Works Compared to Placebo in People with Type 2 Diabetes and Chronic Kidney Disease (FLOW trial) was recently stopped because of efficacy. The primary end point for the FLOW trial consists of a composite endpoint of (i) onset of chronic kidney failure; (ii) death from kidney failure; (iii) cardiovascular death; and (iv) onset of a persistent ≥50% reduction in eGFR from baseline. It has also been reported by the sponsors of the trial that the primary end point of the trial was reduced by 24% with both CKD and CV outcomes contributing to risk reduction. In anticipation of the results of the FLOW trial being published, we review the current evidence surrounding kidney outcomes and proposed kidney protective pathways associated with GLP-1RA use.
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Affiliation(s)
- Philippa Trevella
- Department of Endocrinology & Diabetes, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Elif I Ekinci
- Department of Endocrinology, Austin Health, Melbourne, Vitoria, Australia
- Department of Medicine, Austin Health, Melbourne Medical School, Parkville, Victoria, Australia
- Australian Centre for Accelerating Diabetes Innovations, School of Medicine, University of Melbourne, Parkville, Victoria, Australia
| | - Richard J MacIsaac
- Department of Endocrinology & Diabetes, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
- Australian Centre for Accelerating Diabetes Innovations, School of Medicine, University of Melbourne, Parkville, Victoria, Australia
- Department of Medicine St Vincent's Hospital Melbourne, University of Melbourne, Fitzroy, Vitoria, Australia
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15
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Larsen AT, Mohamed KE, Melander SA, Karsdal MA, Henriksen K. The enduring metabolic improvement of combining dual amylin and calcitonin receptor agonist and semaglutide treatments in a rat model of obesity and diabetes. Am J Physiol Endocrinol Metab 2024; 327:E145-E154. [PMID: 38864815 DOI: 10.1152/ajpendo.00092.2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 06/03/2024] [Accepted: 06/05/2024] [Indexed: 06/13/2024]
Abstract
Long-acting dual amylin and calcitonin receptor agonists (DACRAs) are novel candidates for the treatment of type 2 diabetes and obesity due to their beneficial effects on body weight, glucose control, and insulin action. However, how the metabolic benefits are maintained after long-lasting treatment is unknown. This study investigates the long-term anti-obesity and anti-diabetic treatment efficacy of the DACRA KBP-336 alone and combined with the GLP-1 analog semaglutide. Zucker diabetic Sprague Dawley (ZDSD) rats with obesity and diabetes received KBP-336 (4.5 nmol/kg Q3D), semaglutide (50 nmol/kg Q3D), or the combination for 7 mo, and the treatment impact on body weight, food intake, glucose control, and insulin action was evaluated. Furthermore, serum levels of the cardiac fibrosis biomarker endotrophin were evaluated. KBP-336, semaglutide, and the combination lowered body weight significantly compared with the vehicle, with the combination inducing a larger and more sustained weight loss than either monotherapy. All treatments resulted in reduced fasting blood glucose levels and HbA1c levels and improved glucose tolerance compared with vehicle-treated rats. Furthermore, all treatments protected against lost insulin secretory capacity and improved insulin action. Serum levels of endotrophin were significantly lowered by KBP-336 compared with vehicle. This study shows the benefit of combining KBP-336 and semaglutide to obtain significant and sustained weight loss, as well as improved glucose control. Furthermore, KBP-336-driven reductions in circulating endotrophin indicate a clear reduction in the risk of complications. Altogether, KBP-336 is a promising candidate for the treatment of obesity and type 2 diabetes both alone and in combination with GLP-1 analogs.NEW & NOTEWORTHY These studies describe the benefit of combining dual amylin and calcitonin receptor agonists (DACRA) with semaglutide for long-term treatment of obesity and type 2 diabetes. Combination treatment induced sustained weight loss and improved glucose control. A DACRA-driven reduction in a serological biomarker of cardiac fibrosis indicated a reduced risk of complications. These results highlight DACRAs as a promising candidate for combination treatment of obesity and type 2 diabetes and related long-term complications.
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Affiliation(s)
| | | | | | | | - Kim Henriksen
- Nordic Bioscience, Herlev, Denmark
- KeyBioscience AG, Stans, Switzerland
- Department of Science and Environment, Roskilde University, Roskilde, Denmark
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16
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Hakariya H, Ohnishi M, Tanimoto T. Japan initiates market authorization of weight-loss drug semaglutide under universal health coverage, but with stringent prescription restrictions. Diabetes Obes Metab 2024; 26:3006-3008. [PMID: 38747140 DOI: 10.1111/dom.15638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Revised: 04/11/2024] [Accepted: 04/12/2024] [Indexed: 07/10/2024]
Affiliation(s)
- Hayase Hakariya
- Interfaculty Institute of Biochemistry, University of Tuebingen, Tuebingen, Germany
- Institute for Pharmaceutical and Social Health Sciences, Kyoto, Japan
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17
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Chartoumpekis DV, Chen I, Salvatore SR, Schopfer FJ, Freeman BA, Khoo NKH. Adipocyte-specific Nrf2 deletion negates nitro-oleic acid benefits on glucose tolerance in diet-induced obesity. Nitric Oxide 2024; 149:75-84. [PMID: 38879114 DOI: 10.1016/j.niox.2024.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 06/07/2024] [Accepted: 06/12/2024] [Indexed: 07/07/2024]
Abstract
Obesity is commonly linked with white adipose tissue (WAT) dysfunction, setting off inflammation and oxidative stress, both key contributors to the cardiometabolic complications associated with obesity. To improve metabolic and cardiovascular health, countering these inflammatory and oxidative signaling processes is crucial. Offering potential in this context, the activation of nuclear factor erythroid 2-related factor 2 (Nrf2) by nitro-fatty acids (NO2-FA) promote diverse anti-inflammatory signaling and counteract oxidative stress. Additionally, we previously highlighted that nitro-oleic acid (NO2-OA) preferentially accumulates in WAT and provides protection against already established high fat diet (HFD)-mediated impaired glucose tolerance. The precise mechanism accounting for these protective effects remained largely unexplored until now. Herein, we reveal that protective effects of improved glucose tolerance by NO2-OA is absent when Nrf2 is specifically ablated in adipocytes (ANKO mice). NO2-OA treatment did not alter body weight between ANKO and littermate controls (Nrf2fl/fl) mice on both the HFD and low-fat diet (LFD). As expected, at day 76 (before NO2-OA treatment) and notably at day 125 (daily treatment of 15 mg/kg NO2-OA for 48 days), both HFD-fed Nrf2fl/fl and ANKO mice exhibited increased fat mass and reduced lean mass compared to LFD controls. However, throughout the NO2-OA treatment, no distinction was observed between Nrf2fl/fl and ANKO in the HFD-fed mice as well as in the Nrf2fl/fl mice fed a LFD. Glucose tolerance tests revealed impaired glucose tolerance in HFD-fed Nrf2fl/fl and ANKO compared to LFD-fed Nrf2fl/fl mice. Notably, NO2-OA treatment improved glucose tolerance in HFD-fed Nrf2fl/fl but did not yield the same improvement in ANKO mice at days 15, 30, and 55 of treatment. Unraveling the pathways linked to NO2-OA's protective effects in obesity-mediated impairment in glucose tolerance is pivotal within the realm of precision medicine, crucially propelling future applications and refining novel drug-based strategies.
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Affiliation(s)
- D V Chartoumpekis
- Department of Pharmacology & Chemical Biology, University of Pittsburgh, Pittsburgh, PA, 15261, USA; Service of Endocrinology, Diabetology and Metabolism, Lausanne University Hospital and University of Lausanne, CH-1011, Lausanne, Switzerland
| | - I Chen
- Department of Pharmacology & Chemical Biology, University of Pittsburgh, Pittsburgh, PA, 15261, USA
| | - S R Salvatore
- Department of Pharmacology & Chemical Biology, University of Pittsburgh, Pittsburgh, PA, 15261, USA
| | - F J Schopfer
- Department of Pharmacology & Chemical Biology, University of Pittsburgh, Pittsburgh, PA, 15261, USA; Pittsburgh Liver Research Center, University of Pittsburgh and University of Pittsburgh Medical Center, Pittsburgh, PA, 15261, USA
| | - B A Freeman
- Department of Pharmacology & Chemical Biology, University of Pittsburgh, Pittsburgh, PA, 15261, USA
| | - N K H Khoo
- Department of Pharmacology & Chemical Biology, University of Pittsburgh, Pittsburgh, PA, 15261, USA; Pittsburgh Liver Research Center, University of Pittsburgh and University of Pittsburgh Medical Center, Pittsburgh, PA, 15261, USA.
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18
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Kaplan JM, Zaman A, Abushamat LA. Curbing the Obesity Epidemic: Should GLP-1 Receptor Agonists Be the Standard of Care for Obesity? Curr Cardiol Rep 2024:10.1007/s11886-024-02097-4. [PMID: 39031282 DOI: 10.1007/s11886-024-02097-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/05/2024] [Indexed: 07/22/2024]
Abstract
PURPOSE OF REVIEW This article summarizes the medical management of obesity with an emphasis on incretin-based therapeutics that target the neuro-hormonal basis of obesity. RECENT FINDINGS Medications that mimic the effect of incretins, a group of peptide hormones released in response to nutrient intake that regulate appetite, result in potent and durable weight loss. Glucagon-like peptide 1 (GLP-1) agonists and glucose-dependent insulinotropic polypeptide (GIP) agonists such as semaglutide and tirzepatide are approved by the United States Food and Drug Administration (FDA) for the management of obesity. The SELECT trial demonstrated that semaglutide led to a reduction in major adverse cardiovascular events in patients without diabetes who were either overweight and had preexisting cardiovascular disease or obese. SUMMARY The treatment of obesity is critical to prevent the progression of cardiovascular-kidney-metabolic syndrome. Incretin-based therapies offer remarkable weight loss and reduce major cardiovascular adverse events.
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Affiliation(s)
- Jennifer M Kaplan
- Department of Internal Medicine, Section of Endocrinology, Diabetes, and Metabolism, Baylor College of Medicine, One Baylor Plaza, R618, Houston, TX, 77030, USA
| | - Adnin Zaman
- Department of Internal Medicine. Division of Endocrinology, Diabetes and Metabolism School of Medicine and Dentistry, University of Rochester, Box 693, 601 Elmwood Avenue, Rochester, NY, 14620, USA
| | - Layla A Abushamat
- Department of Internal Medicine, Section of Cardiovascular Research, Baylor College of Medicine, One Baylor Plaza, MS BCM285, Houston, TX, 77030, USA.
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19
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Drucker DJ. The benefits of GLP-1 drugs beyond obesity. Science 2024; 385:258-260. [PMID: 39024455 DOI: 10.1126/science.adn4128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2024]
Abstract
Glucagon-like peptide-1-based medicines have weight loss-independent actions.
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Affiliation(s)
- Daniel J Drucker
- The Lunenfeld-Tanenbaum Research Institute, Mt. Sinai Hospital, and the Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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20
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Lassen MCH, Skaarup KG, Vaduganathan M, Ostrominski JW, Jensen JUS, Biering-Sørensen T, Johansen ND. Forecasting cardiovascular risk reduction with semaglutide in overweight and obese with heart disease: a nationwide cohort study. Eur J Prev Cardiol 2024:zwae224. [PMID: 39021164 DOI: 10.1093/eurjpc/zwae224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 06/20/2024] [Accepted: 06/25/2024] [Indexed: 07/20/2024]
Affiliation(s)
- Mats C Højbjerg Lassen
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, Gentofte Hospitalsvej 1, 2900 Copenhagen, Denmark
- Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Gentofte Hospitalsvej 1, 2900 Hellerup, Denmark
- Department of Medicine, Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Kristoffer Grundtvig Skaarup
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, Gentofte Hospitalsvej 1, 2900 Copenhagen, Denmark
- Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Gentofte Hospitalsvej 1, 2900 Hellerup, Denmark
| | - Muthiah Vaduganathan
- Department of Medicine, Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - John W Ostrominski
- Department of Medicine, Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
- Department of Medicine, Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Jens Ulrik Stæhr Jensen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
- Department of Medicine, Respiratory Medicine Section, Copenhagen University Hospital-Herlev and Gentofte, 2900 Copenhagen, Denmark
| | - Tor Biering-Sørensen
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, Gentofte Hospitalsvej 1, 2900 Copenhagen, Denmark
- Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Gentofte Hospitalsvej 1, 2900 Hellerup, Denmark
- Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, 2100 Copenhagen, Denmark
- Steno Diabetes Center Copenhagen, University of Copenhagen, 2730 Herlev, Denmark
| | - Niklas Dyrby Johansen
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, Gentofte Hospitalsvej 1, 2900 Copenhagen, Denmark
- Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Gentofte Hospitalsvej 1, 2900 Hellerup, Denmark
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21
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Chesnaye NC, Ortiz A, Zoccali C, Stel VS, Jager KJ. The impact of population ageing on the burden of chronic kidney disease. Nat Rev Nephrol 2024:10.1038/s41581-024-00863-9. [PMID: 39025992 DOI: 10.1038/s41581-024-00863-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2024] [Indexed: 07/20/2024]
Abstract
The burden of chronic kidney disease (CKD) and its risk factors are projected to rise in parallel with the rapidly ageing global population. By 2050, the prevalence of CKD category G3-G5 may exceed 10% in some regions, resulting in substantial health and economic burdens that will disproportionately affect lower-income countries. The extent to which the CKD epidemic can be mitigated depends largely on the uptake of prevention efforts to address modifiable risk factors, the implementation of cost-effective screening programmes for early detection of CKD in high-risk individuals and widespread access and affordability of new-generation kidney-protective drugs to prevent the development and delay the progression of CKD. Older patients require a multidisciplinary integrated approach to manage their multimorbidity, polypharmacy, high rates of adverse outcomes, mental health, fatigue and other age-related symptoms. In those who progress to kidney failure, comprehensive conservative management should be offered as a viable option during the shared decision-making process to collaboratively determine a treatment approach that respects the values and wishes of the patient. Interventions that maintain or improve quality of life, including pain management and palliative care services when appropriate, should also be made available.
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Affiliation(s)
- Nicholas C Chesnaye
- ERA Registry, Amsterdam UMC location University of Amsterdam, Medical Informatics, Amsterdam, Netherlands
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
| | - Alberto Ortiz
- Department of Nephrology and Hypertension, IIS-Fundacion Jimenez Diaz UAM, Madrid, Spain
- RICORS2040, Madrid, Spain
| | - Carmine Zoccali
- Associazione Ipertensione Nefrologia Trapianto Renale (IPNET), c/o Nefrologia, Grande Ospedale Metropolitano, Reggio Calabria, Italy
- Institute of Molecular Biology and Genetics (Biogem), Ariano Irpino, Italy
- Renal Research Institute, New York, NY, USA
| | - Vianda S Stel
- ERA Registry, Amsterdam UMC location University of Amsterdam, Medical Informatics, Amsterdam, Netherlands
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
| | - Kitty J Jager
- ERA Registry, Amsterdam UMC location University of Amsterdam, Medical Informatics, Amsterdam, Netherlands.
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands.
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22
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Ostrominski JW, Vaduganathan M. Glucagon-Like Peptide-1 Receptor Agonists in Heart Failure with Reduced Ejection Fraction: Time for a Trial. J Card Fail 2024:S1071-9164(24)00235-5. [PMID: 39032688 DOI: 10.1016/j.cardfail.2024.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2024] [Revised: 07/06/2024] [Accepted: 07/08/2024] [Indexed: 07/23/2024]
Affiliation(s)
- John W Ostrominski
- Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Muthiah Vaduganathan
- Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
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23
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Reddy YNV, Sundaram V. Predicting worsening heart failure with preserved ejection fraction from non-invasive exercise testing. Eur J Heart Fail 2024. [PMID: 39015082 DOI: 10.1002/ejhf.3380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2024] [Accepted: 07/01/2024] [Indexed: 07/18/2024] Open
Affiliation(s)
- Yogesh N V Reddy
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Varun Sundaram
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
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Gaffey RH, Takyi AK, Shukla A. Investigational and emerging gastric inhibitory polypeptide (GIP) receptor-based therapies for the treatment of obesity. Expert Opin Investig Drugs 2024:1-17. [PMID: 38984950 DOI: 10.1080/13543784.2024.2377319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 07/03/2024] [Indexed: 07/11/2024]
Abstract
INTRODUCTION One billion people live with obesity. The most promising medications for its treatment are incretin-based therapies, based on enteroendocrine peptides released in response to oral nutrients, specifically glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic peptide (GIP). The mechanisms by which GLP-1 receptor agonism cause weight reduction are becoming increasingly understood. However, the mechanisms by which GIP receptor-modulating medications cause weight loss remain to be clarified. AREAS COVERED This review describes GLP-1 and GIP physiology and explores the conflicting data regarding GIP and weight management. It details examples of how to reconcile the contradictory findings that both GIP receptor agonism and antagonism cause weight reduction. Specifically, it discusses the concept of 'biased agonism' wherein exogenous peptides cause different post-receptor signaling patterns than native ligands. It discusses how GIP effects in adipose tissue and the central nervous system may cause weight reduction. It describes GIP receptor-modulating compounds and their most current trials regarding weight reduction. EXPERT OPINION Effects of GIP receptor-modulating compounds on different tissues have implications for both weight reduction and other cardiometabolic diseases. Further study is needed to understand the implications of GIP agonism on not just weight reduction, but also cardiovascular disease, liver disease, bone health and fat storage.
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Affiliation(s)
- Robert H Gaffey
- Comprehensive Weight Control Center, Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Afua K Takyi
- Comprehensive Weight Control Center, Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Alpana Shukla
- Comprehensive Weight Control Center, Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
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Palacios S, Chedraui P, Sanchez-Borrego R, Coronado P, Simoncini T, Schauding K, Hillard T, Nappi RE. Management of obesity in menopause. Climacteric 2024:1-7. [PMID: 39016333 DOI: 10.1080/13697137.2024.2374760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 06/25/2024] [Indexed: 07/18/2024]
Abstract
The increasing prevalence of obesity imposes significant health challenges, particularly in women undergoing menopause. Effective obesity management is essential to mitigate associated comorbidities and improve quality of life. The pillars of obesity treatment encompass lifestyle modifications, pharmacotherapy and surgical interventions. Pharmacotherapy may be considered for women who do not achieve adequate weight loss through lifestyle changes alone and have obesity or overweight with risk factors. Bariatric surgery is reserved for individuals with severe obesity or those with obesity-related complications. During menopause, hormonal changes contribute to weight gain and fat redistribution, complicating obesity management. Tailored treatment strategies are necessary to address the unique challenges faced by this population. The role of physicians and gynecologists is pivotal in the multidisciplinary approach to obesity management during menopause. Gynecologists are often the primary health-care providers for menopausal women and are in a unique position to offer guidance on weight management. They can provide personalized counseling, coordinate with nutritionists, endocrinologists and bariatric specialists, and monitor the effects of obesity and its treatment on reproductive health. By integrating obesity management into routine gynecological care, gynecologists can significantly impact the overall health and well-being of menopausal women.
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Affiliation(s)
| | - Peter Chedraui
- Escuela de Postgrado en Salud, Universidad Espíritu Santo, Samborondón, Ecuador
| | | | - Pluvio Coronado
- Women's Health Institute, Hospital Clínico San Carlos, IdISSC, School of Medicine, Complutense University, Madrid, Spain
| | - Tommaso Simoncini
- Division of Obstetrics and Gynecology, Department of Experimental and Clinical Medicine, University of Pisa, Pisa, Italy
| | - Katrin Schauding
- Hormone Hamburg, Practice for Gynecological Endocrinology, Hamburg, Germany
| | - Tim Hillard
- Poole Menopause Centre, University Hospitals Dorset, Poole, UK
| | - Rossella E Nappi
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS San Matteo Foundation, Pavia, Italy
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Krychtiuk KA, Marquis-Gravel G, Murphy S, Alexander KP, Chiswell K, Green JB, Leiter LA, Lopes RD, Del Prato S, Jones WS, McMurray JJV, Hernandez AF, Granger CB. Effects of albiglutide on myocardial infarction and ischaemic heart disease outcomes in patients with type 2 diabetes and cardiovascular disease in the Harmony Outcomes trial. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2024; 10:279-288. [PMID: 38271596 DOI: 10.1093/ehjcvp/pvae006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 12/20/2023] [Accepted: 01/23/2024] [Indexed: 01/27/2024]
Abstract
AIMS Large outcome trials have demonstrated cardiovascular benefits of selected glucagon-like peptide-1 (GLP-1) receptor agonists. We examined coronary disease outcomes in the Harmony Outcomes trial of the GLP-1 receptor agonist albiglutide. METHODS AND RESULTS Harmony Outcomes was an event-driven, multicenter, double-blind, and placebo-controlled trial involving 9463 patients >40 years of age with type-2 diabetes and established atherosclerotic cardiovascular disease. It tested the effects of albiglutide on the occurrence of a composite primary endpoint, consisting of cardiovascular death, myocardial infarction (MI), or stroke. Within this post-hoc analysis, the effects of albiglutide on MI subtypes and other ischaemic endpoints were analysed.During the median-follow up of 1.6 years, a total of 421 patients (4.5%) experienced at least one MI, with 72 patients having more than one event. Treatment with albiglutide reduced both first events [hazard ratio (HR) 0.75 (0.62-0.91)] and overall events [HR 0.75 (0.61-0.91)] as well as first type 1 [HR 0.73 (0.57-0.92)] and type 2 myocardial infarctions [HR 0.65 (0.46-0.92)]. The effect of albiglutide treatment was consistent for ST-segment elevation [HR 0.69 (0.38-1.26)] and non-ST elevation (HR 0.86 (0.66-1.2) MI. CONCLUSION Treatment with the GLP-1 receptor agonist albiglutide resulted in a 25% relative risk reduction in MI that was consistent for type of infarction and presence or absence of ST elevation. Our findings add novel information about the effects of GLP-1 receptor agonists on ischaemic events in patients with type 2 diabetes.
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Affiliation(s)
| | | | | | | | | | | | - Lawrence A Leiter
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, ON M5B 1W8, Canada
| | | | - Stefano Del Prato
- Section on Diabetes, Department of Clinical and Experimental Medicine, University of Pisa, and Sant'Anna School of Advanced Studies, 56126 Pisa, Italy
| | | | - John J V McMurray
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, Glasgow G12 8TA, UK
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27
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Wallner M, Biber ME, Stolfo D, Sinagra G, Benson L, Dahlström U, Gudbjörnsdottir S, Cosentino F, Mol PGM, Rosano GMC, Butler J, Metra M, Lund LH, Ferrannini G, Savarese G. Glucagon-like peptide-1 receptor agonists use and associations with outcomes in heart failure and type 2 diabetes: data from the Swedish Heart Failure and Swedish National Diabetes Registries. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2024; 10:296-306. [PMID: 38632048 PMCID: PMC11250228 DOI: 10.1093/ehjcvp/pvae026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 04/10/2024] [Accepted: 04/16/2024] [Indexed: 04/19/2024]
Abstract
AIMS To assess the use and associations with outcomes of glucagon-like peptide-1 receptor agonists (GLP-1 RA) in a real-world population with heart failure (HF) and type 2 diabetes mellitus (T2DM). METHODS AND RESULTS The Swedish HF Registry was linked with the National Diabetes Registry and other national registries. Independent predictors of GLP-1 RA use were assessed by multivariable logistic regressions and associations with outcomes were assessed by Cox regressions in a 1:1 propensity score-matched cohort. Of 8188 patients enrolled in 2017-21, 9% received a GLP-1 RA. Independent predictors of GLP-1 RA use were age <75 years, worse glycaemic control, impaired renal function, obesity, and reduced ejection fraction (EF). GLP-1 RA use was not significantly associated with a composite of HF hospitalization (HHF) or cardiovascular (CV) death regardless of EF, but was associated with a lower risk of major adverse CV events (CV death, non-fatal stroke/transient ischaemic attack, or myocardial infarction), and CV and all-cause death. In patients with body mass index ≥30 kg/m2, GLP-1 RA use was also associated with a lower risk of HHF/CV death and HHF alone. CONCLUSIONS In patients with HF and T2DM, GLP-1 RA use was independently associated with more severe T2DM, reduced EF, and obesity and was not associated with a higher risk of HHF/CV death but with longer survival and less major CV adverse events. An association with lower HHF/CV death and HHF was observed in obese patients. Our findings provide new insights into GLP-1 RA use and its safety in HF and T2DM.
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Affiliation(s)
- Markus Wallner
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz 8010, Austria
| | - Mattia Emanuele Biber
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Solnavägen 1, 171 77 Solna, Stockholm, Sweden
- Department of Medical Studies, University of Trieste, School of Medicine, Trieste 34149, Italy
| | - Davide Stolfo
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Solnavägen 1, 171 77 Solna, Stockholm, Sweden
- Cardiothoracovascular Department, University of Trieste, Trieste 34149, Italy
| | - Gianfranco Sinagra
- Cardiothoracovascular Department, University of Trieste, Trieste 34149, Italy
| | - Lina Benson
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Solnavägen 1, 171 77 Solna, Stockholm, Sweden
| | - Ulf Dahlström
- Department of Cardiology and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping 58183, Sweden
| | - Soffia Gudbjörnsdottir
- National Diabetes Registry, Centre of Registries, Gothenburg 40530, Sweden
- Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Gothenburg 40530, Sweden
| | - Francesco Cosentino
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Solnavägen 1, 171 77 Solna, Stockholm, Sweden
- Heart and Vascular and Neuro Theme, Karolinska University Hospital, Eugeniavägen 27, Norrbacka, SE-171 64 Stockholm, Sweden
| | - Peter G M Mol
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen 9713, The Netherlands
| | | | - Javed Butler
- University of Mississippi, Jackson, MS 39213, USA
- Baylor Scott and White Research Institute, Dallas, TX 75204, USA
| | - Marco Metra
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia 25121, Italy
| | - Lars H Lund
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Solnavägen 1, 171 77 Solna, Stockholm, Sweden
- Heart and Vascular and Neuro Theme, Karolinska University Hospital, Eugeniavägen 27, Norrbacka, SE-171 64 Stockholm, Sweden
| | - Giulia Ferrannini
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Solnavägen 1, 171 77 Solna, Stockholm, Sweden
| | - Gianluigi Savarese
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Solnavägen 1, 171 77 Solna, Stockholm, Sweden
- Heart and Vascular and Neuro Theme, Karolinska University Hospital, Eugeniavägen 27, Norrbacka, SE-171 64 Stockholm, Sweden
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Redelmeier DA, Zipursky JS. Seeing the Truth About Double Blinding. J Gen Intern Med 2024:10.1007/s11606-024-08887-4. [PMID: 39012541 DOI: 10.1007/s11606-024-08887-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Accepted: 06/11/2024] [Indexed: 07/17/2024]
Abstract
Randomized clinical trials provide reassurances that confounding factors are balanced at baseline whereas blinding is essential to assure the balance of extraneous factors thereafter. This article provides a three-part taxonomy of pitfalls that can arise because of inadequate blinding in clinical trials. We introduce a cautionary framework for readers interpreting a blinded randomized trial for evidence-based medicine. Each pitfall is illustrated with a relevant example of a potential bias resulting from knowledge of group assignment. Several pitfalls occur during the conduct of the study including inadequate blinding of the intervention group, control group, or responsible clinicians. Additional pitfalls relate to data analysis including unsubstantiated assertions of blinding and subverted tests for blinding. Further pitfalls arise due to surrounding oversight including unblinding of research ethics boards and scientific reviewers. These caveats are sources of misunderstanding when observing the apparent connection between a clinical intervention and patient outcomes. An awareness of specific pitfalls might help advance the interpretation and application of blinded randomized clinical trials to inform evidence-based medical care.
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Affiliation(s)
- Donald A Redelmeier
- Department of Medicine, University of Toronto, Toronto, ON, Canada.
- Evaluative Clinical Sciences Program, Sunnybrook Research Institute, Toronto, Canada.
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.
- Division of General Internal Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
| | - Jonathan S Zipursky
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Evaluative Clinical Sciences Program, Sunnybrook Research Institute, Toronto, Canada
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
- Division of General Internal Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Division of Clinical Pharmacology & Toxicology, University of Toronto, Toronto, Canada
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29
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Watts GF, Tamehri Zadeh SS, Chan DC. ANGPTL3 as a therapeutic target for treating homozygous familial hypercholesterolaemia: a shot in the arm for evinacumab. Eur Heart J 2024; 45:2435-2438. [PMID: 38856677 DOI: 10.1093/eurheartj/ehae321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/11/2024] Open
Affiliation(s)
- Gerald F Watts
- Medical School, University of Western Australia, GPO Box X2213, Perth, WA 6847, Australia
- Cardiometabolic Clinic, Department of Cardiology and Internal Medicine, Royal Perth Hospital, Perth, Australia
| | | | - Dick C Chan
- Medical School, University of Western Australia, GPO Box X2213, Perth, WA 6847, Australia
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30
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Kramer CK, Retnakaran M, Viana LV. Effect of Glucagon-like Peptide-1 Receptor Agonists (GLP-1RA) on Weight Loss Following Bariatric Treatment. J Clin Endocrinol Metab 2024; 109:e1634-e1641. [PMID: 38488042 DOI: 10.1210/clinem/dgae176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Indexed: 07/13/2024]
Abstract
CONTEXT There has been growing recognition of the need for considering weight-loss strategies following metabolic bariatric surgery (MBS) to limit the magnitude of potential weight regain. The use of glucagon-like peptide-1 receptor agonists (GLP-1RAs) in this setting remains uncertain. OBJECTIVE We conducted a systematic review and meta-analysis to evaluate the effect of GLP-1RAs on weight changes in patients who previously underwent MBS. METHODS We examined the effect of GLP-1RAs on weight changes by calculating pooled estimates (random-effects model) of the absolute differences in body weight (kg) compared to baseline for observational studies and compared to a control group for randomized controlled trials (RCTs). A total of 17 studies (1164 participants) met our inclusion criteria. Pooling the data from the 14 observational studies evaluating the effect of GLP-1RAs post bariatric treatment demonstrated a reduction of 7.83 kg compared to pre treatment (before the use of GLP-1RA) (weight-7.83 kg [95% CI, -9.27 to -6.38]). With respect to tolerability, 23% (95% CI, 10%-36%) of participants reported any adverse event but only 7% discontinued treatment. Data from RCTs showed that the use of GLP-1RAs induced weight reduction of 4.36 kg (95% CI, -0.42 to -8.30) compared to placebo with a similar safety profile. CONCLUSION Our findings suggest that the use of liraglutide and semaglutide in patients who previously underwent MBS can promote significant weight reduction with an acceptable safety profile.
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Affiliation(s)
- Caroline K Kramer
- Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, ON M5T 3L9, Canada
- Division of Endocrinology, University of Toronto, Toronto, ON M5T 3L9, Canada
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON M5T 3L9, Canada
| | - Matthew Retnakaran
- Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, ON M5T 3L9, Canada
| | - Luciana V Viana
- Division of Endocrinology, Hospital de Clínicas de Porto Alegre, Porto Alegre 90035-903, Brazil
- Post-graduate Program in Medical Sciences: Endocrinology, Universidade Federal do Rio Grande do Sul, Porto Alegre 90035-903, Brazil
- Serviço de Nutrologia-Comissão de Suporte Nutricional, Hospital de Clínicas de Porto Alegre, Porto Alegre 90035-903, Brazil
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31
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Reddy YNV, Carter RE, Sundaram V, Kaye DM, Handoko ML, Tedford RJ, Andersen MJ, Sharma K, Obokata M, Verbrugge FH, Borlaug BA. An evidence-based screening tool for heart failure with preserved ejection fraction: the HFpEF-ABA score. Nat Med 2024:10.1038/s41591-024-03140-1. [PMID: 38997608 DOI: 10.1038/s41591-024-03140-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 06/18/2024] [Indexed: 07/14/2024]
Abstract
Heart failure with preserved ejection fraction (HFpEF) is under-recognized in clinical practice. Although a previously developed risk score, termed H2FPEF, can be used to estimate HFpEF probability, this score requires imaging data, which is often unavailable. Here we sought to develop an HFpEF screening model that is based exclusively on clinical variables and that can guide the need for echocardiography and further testing. In a derivation cohort (n = 414, 249 women), a clinical model using age, body mass index and history of atrial fibrillation (termed the HFpEF-ABA score) showed good discrimination (area under the curve (AUC) = 0.839 (95% confidence interval (CI) = 0.800-0.877), P < 0.0001). The performance of the model was validated in an international, multicenter cohort (n = 736, 443 women; AUC = 0.813 (95% CI = 0.779-0.847), P < 0.0001) and further validated in two additional cohorts: a cohort including patients with unexplained dyspnea (n = 228, 136 women; AUC = 0.840 (95% CI = 0.782-0.900), P < 0.0001) and a cohort for which HF hospitalization was used instead of hemodynamics to establish an HFpEF diagnosis (n = 456, 272 women; AUC = 0.929 (95% CI = 0.909-0.948), P < 0.0001). Model-based probabilities were also associated with increased risk of HF hospitalization or death among patients from the Mayo Clinic (n = 790) and a US national cohort across the Veteran Affairs health system (n = 3076, 110 women). Using the HFpEF-ABA score, rapid and efficient screening for risk of undiagnosed HFpEF can be performed in patients with dyspnea using only age, body mass index and history of atrial fibrillation.
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Affiliation(s)
- Yogesh N V Reddy
- The Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Rickey E Carter
- Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL, USA
| | - Varun Sundaram
- Department of Cardiology, Louis Stokes Cleveland Department of Veteran Affairs, Case Western Reserve University, Cleveland, OH, USA
| | - David M Kaye
- Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia
| | - M Louis Handoko
- Departments of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences (ACS), Amsterdam, the Netherlands
| | - Ryan J Tedford
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Mads J Andersen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Kavita Sharma
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Masaru Obokata
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Frederik H Verbrugge
- Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
- Centre for Cardiovascular Diseases, University Hospital Brussels, Brussels, Belgium
| | - Barry A Borlaug
- The Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA.
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32
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Lecube A. [Impact of obesity and diabetes on health and cardiovascular disease]. Aten Primaria 2024; 56:103045. [PMID: 39002301 DOI: 10.1016/j.aprim.2024.103045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Accepted: 06/12/2024] [Indexed: 07/15/2024] Open
Abstract
Obesity and type 2 diabetes mellitus (T2D) significantly increase the risk of cardiovascular diseases such as coronary artery disease, atrial fibrillation, heart failure, and sudden cardiac death. This risk is proportional to body mass index (BMI), is exacerbated by comorbidities such as hypertension and dyslipidemia, and includes emerging risk factors like insulin resistance, low-grade chronic inflammation, and thrombosis tendency. The distribution of adipose tissue, especially visceral fat and ectopic deposition in the heart, is another key factor in the development of cardiovascular diseases in these patients, along with atrial and ventricular remodeling. Bariatric surgery has been shown to be effective in reducing these risks. The prevention and treatment of cardiovascular diseases in obesity and T2D include lifestyle changes, specific pharmacological treatment and management of comorbidities, and attention to cardiovascular risk factors.
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Affiliation(s)
- Albert Lecube
- Servicio de Endocrinología y Nutrición, Hospital Universitari Arnau de Vilanova, Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de Lleida (UdL), Lleida, España.
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Janez A, Muzurovic E, Bogdanski P, Czupryniak L, Fabryova L, Fras Z, Guja C, Haluzik M, Kempler P, Lalic N, Mullerova D, Stoian AP, Papanas N, Rahelic D, Silva-Nunes J, Tankova T, Yumuk V, Rizzo M. Modern Management of Cardiometabolic Continuum: From Overweight/Obesity to Prediabetes/Type 2 Diabetes Mellitus. Recommendations from the Eastern and Southern Europe Diabetes and Obesity Expert Group. Diabetes Ther 2024:10.1007/s13300-024-01615-5. [PMID: 38990471 DOI: 10.1007/s13300-024-01615-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Accepted: 06/20/2024] [Indexed: 07/12/2024] Open
Abstract
The increasing global incidence of obesity and type 2 diabetes mellitus (T2D) underscores the urgency of addressing these interconnected health challenges. Obesity enhances genetic and environmental influences on T2D, being not only a primary risk factor but also exacerbating its severity. The complex mechanisms linking obesity and T2D involve adiposity-driven changes in β-cell function, adipose tissue functioning, and multi-organ insulin resistance (IR). Early detection and tailored treatment of T2D and obesity are crucial to mitigate future complications. Moreover, personalized and early intensified therapy considering the presence of comorbidities can delay disease progression and diminish the risk of cardiorenal complications. Employing combination therapies and embracing a disease-modifying strategy are paramount. Clinical trials provide evidence confirming the efficacy and safety of glucagon-like peptide 1 receptor agonists (GLP-1 RAs). Their use is associated with substantial and durable body weight reduction, exceeding 15%, and improved glucose control which further translate into T2D prevention, possible disease remission, and improvement of cardiometabolic risk factors and associated complications. Therefore, on the basis of clinical experience and current evidence, the Eastern and Southern Europe Diabetes and Obesity Expert Group recommends a personalized, polymodal approach (comprising GLP-1 RAs) tailored to individual patient's disease phenotype to optimize diabetes and obesity therapy. We also expect that the increasing availability of dual GLP-1/glucose-dependent insulinotropic polypeptide (GIP) agonists will significantly contribute to the modern management of the cardiometabolic continuum.
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Affiliation(s)
- Andrej Janez
- Department of Endocrinology, Diabetes and Metabolic Diseases, University Medical Center Ljubljana, Ljubljana, Slovenia.
| | - Emir Muzurovic
- Department of Internal Medicine, Endocrinology Section, Clinical Centre of Montenegro, Faculty of Medicine, University of Montenegro, Podgorica, Montenegro
| | - Pawel Bogdanski
- Department of Treatment of Obesity, Metabolic Disorders and Clinical Dietetics, University of Medical Sciences, Poznan, Poland
| | - Leszek Czupryniak
- Department of Diabetology and Internal Medicine, Medical University of Warsaw, Warszawa, Poland
| | - Lubomira Fabryova
- MetabolKLINIK sro, Department for Diabetes and Metabolic Disorders, Lipid Clinic, MED PED Centre, Biomedical Research Centre of Slovak Academy of Sciences, Slovak Health University, Bratislava, Slovak Republic
| | - Zlatko Fras
- Preventive Cardiology Unit, Division of Medicine, University Medical Centre Ljubljana and Chair of Internal Medicine, Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Cristian Guja
- Clinic of Diabetes, Nutrition and Metabolic Diseases, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Martin Haluzik
- Diabetes Centre, Institute for Clinical and Experimental Medicine, Vídeňská 1958/9, 140 21, Prague 4, Czech Republic
| | - Peter Kempler
- Department of Medicine and Oncology, Semmelweis University, Budapest, Hungary
| | - Nebojsa Lalic
- Faculty of Medicine, Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia, University of Belgrade, Belgrade, Serbia
| | - Dana Mullerova
- Faculty of Medicine in Pilsen, Department of Public Health and Preventive Medicine and Faculty Hospital in Pilsen, 1st Internal Clinic, Charles University, Pilsen, Czech Republic
| | - Anca Pantea Stoian
- Diabetes, Nutrition and Metabolic Diseases Department, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Nikolaos Papanas
- Diabetes Centre, Second Department of Internal Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Dario Rahelic
- Vuk Vrhovac University Clinic for Diabetes, Endocrinology and Metabolic Diseases, Merkur University Hospital, Zagreb, Croatia
- Catholic University of Croatia School of Medicine, Zagreb, Croatia
- Josip Juraj Strossmayer, University of Osijek School of Medicine, Osijek, Croatia
| | - José Silva-Nunes
- NOVA Medical School, New University of Lisbon, Lisbon, Portugal
- Department of Endocrinology, Diabetes and Metabolism, Unidade Local de Saúde São José, Lisbon, Portugal
| | - Tsvetalina Tankova
- Department of Endocrinology, Faculty of Medicine, Medical University, Sofia, Bulgaria
| | - Volkan Yumuk
- Division of Endocrinology, Metabolism and Diabetes, Istanbul University-Cerrahpaşa, Cerrahpaşa Medical Faculty, Istanbul, Turkey
| | - Manfredi Rizzo
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (Promise), School of Medicine, University of Palermo, Palermo, Italy
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Herrington WG, Haynes R. Diabetic Kidney Disease - Semaglutide Flows into the Mainstream. N Engl J Med 2024; 391:178-179. [PMID: 38986062 DOI: 10.1056/nejme2406408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/12/2024]
Affiliation(s)
- William G Herrington
- From the Renal Studies Group, Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Richard Haynes
- From the Renal Studies Group, Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
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35
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Ostrominski JW, Solomon SD, Vaduganathan M. Heart failure with preserved ejection fraction therapy: combining sodium-glucose co-transporter 2 inhibitors and glucagon-like peptide-1 receptor agonists. Eur Heart J 2024:ehae414. [PMID: 38982938 DOI: 10.1093/eurheartj/ehae414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/11/2024] Open
Affiliation(s)
- John W Ostrominski
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115, USA
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Scott D Solomon
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115, USA
| | - Muthiah Vaduganathan
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115, USA
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Somani S, Jain SS, Sarraju A, Sandhu AT, Hernandez-Boussard T, Rodriguez F. Using large language models to assess public perceptions around glucagon-like peptide-1 receptor agonists on social media. COMMUNICATIONS MEDICINE 2024; 4:137. [PMID: 38987347 PMCID: PMC11237093 DOI: 10.1038/s43856-024-00566-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 07/02/2024] [Indexed: 07/12/2024] Open
Abstract
BACKGROUND The prevalence of obesity has been increasing worldwide, with substantial implications for public health. Obesity is independently associated with cardiovascular morbidity and mortality and is estimated to cost the health system over $200 billion dollars annually. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have emerged as a practice-changing therapy for weight loss and cardiovascular risk reduction independent of diabetes. METHODS We used large language models to augment our previously reported artificial intelligence-enabled topic modeling pipeline to analyze over 390,000 unique GLP-1 RA-related Reddit discussions. RESULTS We find high interest around GLP-1 RAs, with a total of 168 topics and 33 groups focused on the GLP-1 RA experience with weight loss, comparison of side effects between differing GLP-1 RAs and alternate therapies, issues with GLP-1 RA access and supply, and the positive psychological benefits of GLP-1 RAs and associated weight loss. Notably, public sentiment in these discussions was mostly neutral-to-positive. CONCLUSIONS These findings have important implications for monitoring new side effects not captured in randomized control trials and understanding the public health challenge of drug shortages.
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Affiliation(s)
- Sulaiman Somani
- Department of Medicine, Stanford University, Stanford, CA, USA
| | - Sneha S Jain
- Division of Cardiovascular Medicine and the Cardiovascular Institute, Stanford University, Stanford, CA, USA
| | - Ashish Sarraju
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Alexander T Sandhu
- Division of Cardiovascular Medicine and the Cardiovascular Institute, Stanford University, Stanford, CA, USA
| | - Tina Hernandez-Boussard
- Department of Medicine, Stanford University, Stanford, CA, USA
- Department of Biomedical Data Science, Stanford University, Stanford, CA, USA
| | - Fatima Rodriguez
- Division of Cardiovascular Medicine and the Cardiovascular Institute, Stanford University, Stanford, CA, USA.
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Rossing P, Hansen TW, Kümler T. Cardiovascular and non-renal complications of chronic kidney disease: Managing risk. Diabetes Obes Metab 2024. [PMID: 38982587 DOI: 10.1111/dom.15747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 06/11/2024] [Accepted: 06/13/2024] [Indexed: 07/11/2024]
Abstract
Chronic kidney disease (CKD) currently affects approximately 850 million people globally and is continuing to increase in prevalence as well as in importance as a cause of death. The excess mortality related to CKD is mostly caused by an increase in cardiovascular disease. This includes atherosclerotic cardiovascular disease as many promoters of atherosclerosis, such as blood pressure, lipid levels and hypercoagulation, are increased in people with CKD. Diabetes is a leading cause of CKD contributing to the risk of CVD, and obesity is also increasingly prevalent. Management of these risk factors is therefore very important in CKD, and to reduce risk of CKD progression. Heart failure is also more prevalent in CKD and, again, many risk factors are shared. The concept of foundational pillars in the management of heart failure has been adapted to the treatment of CKD, with many organ-protective interventions, such renin-angiotensin system blockade, sodium-glucose cotransporter-2 inhibition and mineralocorticoid receptor antagonism, reducing the risk for mortality in heart failure with reduced ejection fraction, but also for progression of CKD. Atrial fibrillation is also more common with CKD and affects the management of the former. In this review these non-renal complications of CKD are discussed, along with how the risk of these complications should be managed. Many new opportunities have demonstrated heart and kidney organ protection, but implementation is a challenge.
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Affiliation(s)
- Peter Rossing
- Clinical Translational Research, Steno Diabetes Center Copenhagen, Herlev, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Tine Willum Hansen
- Clinical Translational Research, Steno Diabetes Center Copenhagen, Herlev, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Kümler
- Clinical Translational Research, Steno Diabetes Center Copenhagen, Herlev, Denmark
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Overgaard KS, Mohamed RA, Andersen TR, Lambrechtsen J, Egstrup K, Auscher S. ProtecT-2-D trial protocol: cardiovascular protection in patients with type 2 diabetes and established heart and/or vascular disease at a cardio-metabolic clinic-a randomized controlled trial. Cardiovasc Diabetol 2024; 23:241. [PMID: 38978117 PMCID: PMC11232310 DOI: 10.1186/s12933-024-02340-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Accepted: 06/26/2024] [Indexed: 07/10/2024] Open
Abstract
BACKGROUND Cardiovascular disease remains the primary cause of morbidity and mortality despite advancements in the treatment of patients with type 2 diabetes. Effective diabetes management extends beyond blood glucose control and includes cardiovascular prevention and treatment. However, the conventional healthcare model often emphasizes single-disease-specific management, leading to fragmented care. We aim to establish an affordable Cardio-Metabolic Clinic (CMC) that can provide comprehensive assessment and specialized care with a focus on cardiovascular protection. METHODS The ProtecT-2-D study is a prospective, randomized control trial at the Cardiovascular Research Unit, Odense University Hospital Svendborg, Denmark. In this study, 1500 participants with type 2 diabetes and cardiovascular disease will be randomly assigned in a 2:1 ratio to receive either the intervention: treatment in the CMC, or the control: standard of care. The Cardio-Metabolic Clinic applies a decision-making algorithm coded with the latest guidelines to evaluate lifestyle factors and manage medical treatment. Health examinations are conducted at baseline and after three years, and clinical events will be assessed through registry and journal audits after five and ten years. The primary outcome is the time to the first occurrence of a composite of cardiovascular deaths, non-fatal acute myocardial infarctions, non-fatal stroke, or hospitalization due to heart failure at a time frame of five years. DISCUSSION The Cardio-Metabolic Clinic represents a pioneering approach to diabetes management that aims to improve patient outcomes by reducing the cardiovascular disease burden. This study could transform diabetes care and offer a multidisciplinary, cost-effective, and specialized treatment. We need to establish the efficacy and feasibility of a CMC to integrate comparable clinics into broader healthcare systems, and potentially enhance cardiovascular health in patients with type 2 diabetes. TRIAL REGISTRATION NUMBER ClinicalTrials.gov NCT06203860.
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Affiliation(s)
- Katrine Schultz Overgaard
- Cardiovascular Research Unit, Odense University Hospital Svendborg, Baagøes Allé 15, 5700, Svendborg, Denmark.
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark.
| | - Roda Abdulkadir Mohamed
- Cardiovascular Research Unit, Odense University Hospital Svendborg, Baagøes Allé 15, 5700, Svendborg, Denmark
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark
| | - Thomas Rueskov Andersen
- Cardiovascular Research Unit, Odense University Hospital Svendborg, Baagøes Allé 15, 5700, Svendborg, Denmark
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark
| | - Jess Lambrechtsen
- Cardiovascular Research Unit, Odense University Hospital Svendborg, Baagøes Allé 15, 5700, Svendborg, Denmark
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark
| | - Kenneth Egstrup
- Cardiovascular Research Unit, Odense University Hospital Svendborg, Baagøes Allé 15, 5700, Svendborg, Denmark
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark
| | - Søren Auscher
- Cardiovascular Research Unit, Odense University Hospital Svendborg, Baagøes Allé 15, 5700, Svendborg, Denmark
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark
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Apperloo EM, Neuen BL, Fletcher RA, Jongs N, Anker SD, Bhatt DL, Butler J, Cherney DZI, Herrington WG, Inzucchi SE, Jardine MJ, Liu CC, Mahaffey KW, McGuire DK, McMurray JJV, Neal B, Packer M, Perkovic V, Sabatine MS, Solomon SD, Staplin N, Szarek M, Vaduganathan M, Wanner C, Wheeler DC, Wiviott SD, Zannad F, Heerspink HJL. Efficacy and safety of SGLT2 inhibitors with and without glucagon-like peptide 1 receptor agonists: a SMART-C collaborative meta-analysis of randomised controlled trials. Lancet Diabetes Endocrinol 2024:S2213-8587(24)00155-4. [PMID: 38991584 DOI: 10.1016/s2213-8587(24)00155-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 05/15/2024] [Accepted: 05/20/2024] [Indexed: 07/13/2024]
Abstract
BACKGROUND SGLT2 inhibitors and GLP-1 receptor agonists both improve cardiovascular and kidney outcomes in patients with type 2 diabetes. We sought to evaluate whether the benefits of SGLT2 inhibitors are consistent in patients receiving and not receiving GLP-1 receptor agonists. METHODS We conducted a collaborative meta-analysis of trials included in the SGLT2 Inhibitor Meta-Analysis Cardio-Renal Trialists' Consortium, restricted to participants with diabetes. Treatment effects from individual trials were obtained from Cox regression models and pooled using inverse variance weighted meta-analysis. The two main cardiovascular outcomes assessed included major adverse cardiovascular events (nonfatal myocardial infarction, nonfatal stroke, or cardiovascular death), and hospitalisation for heart failure or cardiovascular death. The main kidney outcomes assessed were chronic kidney disease progression (≥40% decline in estimated glomerular filtration rate [eGFR], kidney failure [eGFR <15 mL/min/1·73 m2, chronic dialysis, or kidney transplantation], or death due to kidney failure), and the rate of change in eGFR over time. Safety outcomes were also assessed. FINDINGS Across 12 randomised, double-blind, placebo-controlled trials, 3065 (4·2%) of 73 238 participants with diabetes were using GLP-1 receptor agonists at baseline. SGLT2 inhibitors reduced the risk of major adverse cardiovascular events in participants both receiving and not receiving GLP-1 receptor agonists (hazard ratio [HR] 0·81, 95% CI 0·63-1·03 vs 0·90, 0·86-0·94; p-heterogeneity=0·31). Effects on hospitalisation for heart failure or cardiovascular death (0·76, 0·57-1·01 vs 0·78, 0·74-0·82; p-heterogeneity=0·90) and chronic kidney disease progression (0·65, 0·46-0·94 vs 0·67, 0·62-0·72; p-heterogeneity=0·81) were also consistent regardless of GLP-1 receptor agonist use, as was the effect on the chronic rate of change in eGFR over time (heterogeneity=0·92). Fewer serious adverse events occurred with SGLT2 inhibitors compared with placebo, irrespective of GLP-1 receptor agonist use (relative risk 0·87, 95% CI 0·79-0·96 vs 0·91, 0·89-0·93; p-heterogeneity=0·41). INTERPRETATION The effects of SGLT2 inhibitors on cardiovascular and kidney outcomes are consistent regardless of the background use of GLP-1 receptor agonists. These findings suggest independent effects of these evidence-based therapies and support clinical practice guidelines recommending the use of these agents in combination to improve cardiovascular and kidney metabolic outcomes. FUNDING National Health and Medical Research Council of Australia and the Ramaciotti Foundation.
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Affiliation(s)
- Ellen M Apperloo
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Centre Groningen, Groningen, Netherlands
| | - Brendon L Neuen
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia; Department of Renal Medicine, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Robert A Fletcher
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Niels Jongs
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Centre Groningen, Groningen, Netherlands
| | - Stefan D Anker
- Department of Cardiology and Berlin Institute of Health Center for Regenerative Therapies, German Center for Cardiovascular Research Partner Site Berlin, Charité Universitätsmedizin, Berlin, Germany
| | - Deepak L Bhatt
- Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Javed Butler
- Baylor Scott and White Research Institute, Dallas, TX, USA; Department of Medicine, University of Mississippi School of Medicine, Jackson, MS, USA
| | - David Z I Cherney
- Department of Medicine, Division of Nephrology, Toronto General Hospital, ON, Canada
| | - William G Herrington
- Renal Studies Group, Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Silvio E Inzucchi
- Section of Endocrinology, Yale School of Medicine, New Haven, CT, USA
| | - Meg J Jardine
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia; NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia; Department of Renal Medicine, Concord Repatriation General Hospital, Sydney, NSW, Australia
| | | | - Kenneth W Mahaffey
- Stanford Center for Clinical Research, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Darren K McGuire
- University of Texas Southwestern Medical Center and Parkland Health, Dallas, TX, USA
| | - John J V McMurray
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Bruce Neal
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia; Department of Epidemiology and Biostatistics, Imperial College London, London, UK
| | - Milton Packer
- Baylor University Medical Center, Dallas TX, USA; Imperial College, London, UK
| | - Vlado Perkovic
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Marc S Sabatine
- TIMI Study Group, Boston, MA, USA; Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Scott D Solomon
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Natalie Staplin
- Renal Studies Group, Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Michael Szarek
- Division of Cardiology, University of Colorado School of Medicine, Aurora, CO, USA; Colorado Prevention Center Clinical Research, Aurora, CO, USA; State University of New York, Downstate Health Sciences University, Brooklyn, NY, USA
| | - Muthiah Vaduganathan
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Christoph Wanner
- Department of Clinical Research and Epidemiology, Comprehensive Heart Failure Centre, University Hospital, Würzburg, Germany
| | - David C Wheeler
- Department of Renal Medicine, University College London, London, UK
| | - Stephen D Wiviott
- TIMI Study Group, Boston, MA, USA; Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Faiez Zannad
- Université de Lorraine, Inserm, Center d'Investigations Cliniques, Plurithématique 14-33, and Inserm U1116, CHRU, F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France
| | - Hiddo J L Heerspink
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Centre Groningen, Groningen, Netherlands; The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia.
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Rodriguez PJ, Goodwin Cartwright BM, Gratzl S, Brar R, Baker C, Gluckman TJ, Stucky NL. Semaglutide vs Tirzepatide for Weight Loss in Adults With Overweight or Obesity. JAMA Intern Med 2024:2821080. [PMID: 38976257 PMCID: PMC11231910 DOI: 10.1001/jamainternmed.2024.2525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 04/14/2024] [Indexed: 07/09/2024]
Abstract
Importance Although tirzepatide and semaglutide were shown to reduce weight in randomized clinical trials, data from head-to-head comparisons in populations with overweight or obesity are not yet available. Objective To compare on-treatment weight loss and rates of gastrointestinal adverse events (AEs) among adults with overweight or obesity receiving tirzepatide or semaglutide labeled for type 2 diabetes (T2D) in a clinical setting. Design, Setting, and Participants In this cohort study, adults with overweight or obesity receiving semaglutide or tirzepatide between May 2022 and September 2023 were identified using electronic health record (EHR) data linked to dispensing information from a collective of US health care systems. On-treatment weight outcomes through November 3, 2023, were assessed. Adults with overweight or obesity and regular care in the year before initiation, no prior glucagon-like peptide 1 receptor agonist receptor agonist use, a prescription within 60 days prior to initiation, and an available baseline weight were identified. The analysis was completed on April 3, 2024. Exposures Tirzepatide or semaglutide in formulations labeled for T2D, on or off label. Main Outcomes and Measures On-treatment weight change in a propensity score-matched population, assessed as hazard of achieving 5% or greater, 10% or greater, and 15% or greater weight loss, and percentage change in weight at 3, 6, and 12 months. Hazards of gastrointestinal AEs were compared. Results Among 41 222 adults meeting the study criteria (semaglutide, 32 029; tirzepatide, 9193), 18 386 remained after propensity score matching. The mean (SD) age was 52.0 (12.9) years, 12 970 were female (70.5%), 14 182 were white (77.1%), 2171 Black (11.8%), 354 Asian (1.9%), 1679 were of other or unknown race, and 9563 (52.0%) had T2D. The mean (SD) baseline weight was 110 (25.8) kg. Follow-up was ended by discontinuation for 5140 patients (55.9%) receiving tirzepatide and 4823 (52.5%) receiving semaglutide. Patients receiving tirzepatide were significantly more likely to achieve weight loss (≥5%; hazard ratio [HR], 1.76, 95% CI, 1.68, 1.84; ≥10%; HR, 2.54; 95% CI, 2.37, 2.73; and ≥15%; HR, 3.24; 95% CI, 2.91, 3.61). On-treatment changes in weight were larger for patients receiving tirzepatide at 3 months (difference, -2.4%; 95% CI -2.5% to -2.2%), 6 months (difference, -4.3%; 95% CI, -4.7% to -4.0%), and 12 months (difference, -6.9%; 95% CI, -7.9% to -5.8%). Rates of gastrointestinal AEs were similar between groups. Conclusions and Relevance In this population of adults with overweight or obesity, use of tirzepatide was associated with significantly greater weight loss than semaglutide. Future study is needed to understand differences in other important outcomes.
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Affiliation(s)
| | | | | | | | | | - Ty J. Gluckman
- Center for Cardiovascular Analytics, Research and Data Science (CARDS), Providence Heart Institute, Providence Health System, Portland, Oregon
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Horváth L, Mráz M, Jude EB, Haluzík M. Pharmacotherapy as an Augmentation to Bariatric Surgery for Obesity. Drugs 2024:10.1007/s40265-024-02029-0. [PMID: 38970626 DOI: 10.1007/s40265-024-02029-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2024] [Indexed: 07/08/2024]
Abstract
A global obesity pandemic is one of the most significant health threats worldwide owing to its close association with numerous comorbidities such as type 2 diabetes mellitus, arterial hypertension, dyslipidemia, heart failure, cancer and many others. Obesity and its comorbidities lead to a higher rate of cardiovascular complications, heart failure and increased cardiovascular and overall mortality. Bariatric surgery is at present the most potent therapy for obesity, inducing a significant weight loss in the majority of patients. In the long-term, a substantial proportion of patients after bariatric surgery experience a gradual weight regain that may, in some, reach up to a presurgical body weight. As a result, anti-obesity pharmacotherapy may be needed in some patients after bariatric surgery to prevent the weight regain or to further potentiate weight loss. This article provides an overview of the use of anti-obesity medications as an augmentation to bariatric surgery for obesity. Despite relatively limited published data, it can be concluded that anti-obesity medication can serve as an effective adjunct therapy to bariatric surgery to help boost post-bariatric weight loss or prevent weight regain.
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Affiliation(s)
- Luděk Horváth
- Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Miloš Mráz
- Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Edward B Jude
- Tameside and Glossop Integrated Care NHS Foundation Trust, Ashton-under-Lyne and University of Manchester, Manchester, United Kingdom.
| | - Martin Haluzík
- Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
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Petroni ML, Perazza F, Marchesini G. Breakthrough in the Treatment of Metabolic Associated Steatotic Liver Disease: Is it all over? Dig Liver Dis 2024:S1590-8658(24)00722-9. [PMID: 38972788 DOI: 10.1016/j.dld.2024.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 04/22/2024] [Indexed: 07/09/2024]
Abstract
On March 14, 2024, after more than 25 years of intense research and a long series of failures, the Food and Drug Administration approved resmetirom as first drug for the treatment of non-alcoholic steatohepatitis (NASH) with fibrosis (now Metabolic-Associated Steatotic Liver Disease - MASLD). The present review covers this difficult process, finally providing a drug to complement lifestyle intervention, that has long been the sole approved therapeutic intervention. However, the availability of a drug shown to reduce disease progression in advanced stages of diseases opens a series of questions that deserve even more intense research. How to continue ongoing trials? How to generate an appropriate use of resmetirom in the community, limiting treatment according to predefined criteria and according to individual risk assessment? How to guarantee that both hepatic and non-hepatic comorbidities are appropriately targeted? How to define cost-effective strategies that might prevent the generation of unacceptable differences within the population, given the high costs of novel drugs and the extremely high numbers of candidates to treatment? Only a close surveillance of drug use in the real world, generated by insurance databases and national healthcare system registries, might provide adequate answers to these compelling questions.
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Affiliation(s)
- Maria Letizia Petroni
- Unit of Clinical Nutrition and Metabolism, IRCCS-Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Federica Perazza
- Unit of Clinical Nutrition and Metabolism, IRCCS-Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Alma Mater University, Bologna, Italy
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Pratley R, Saeed ZI, Casu A. Incretin mimetics and acute pancreatitis: enemy or innocent bystander? Curr Opin Gastroenterol 2024:00001574-990000000-00162. [PMID: 38967917 DOI: 10.1097/mog.0000000000001057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/06/2024]
Abstract
PURPOSE OF REVIEW The incretin enhancers and mimetics, including dipeptidyl peptidase-4 (DPP-4) inhibitors, GLP-1 receptor agonists (GLP-1RA) and GLP-1/GIP co-agonists, have become mainstays in the treatment of type 2 diabetes (T2D). Recently, the approval of certain GLP-1RA and GLP-1/GIP co-agonists for the treatment of obesity has broadened their popularity and use. In this review, we summarize the evidence for an association of these drugs with acute pancreatitis and other adverse events of special interest to gastroenterologists. RECENT FINDINGS In addition to pancreatic islets, GLP-1 receptors are expressed in the exocrine cells of the pancreas. There is inconsistent evidence for an association of DPP-4 inhibitors, GLP-1RA and co-agonists with risk for acute pancreatitis in individual trials. Meta-analyses of long-term randomized controlled trials indicate a small risk of acute pancreatitis associated with DPP-4 inhibitors but not GLP-1RA or co-agonists. Cholecystitis and cholelithiasis may be more common among those treated with GLP-1RA and GLP-1/GIP co-agonists. There is no evidence that any of these drugs are associated with an increased risk of pancreatic cancer. SUMMARY While drugs that leverage the incretin system are increasingly being used for patients with T2D and obesity, caution in warranted in those with a history of pancreatitis and gallbladder disease.
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Affiliation(s)
- Richard Pratley
- AdventHealth Translational Research Institute, Orlando, Florida
| | - Zeb I Saeed
- Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Anna Casu
- AdventHealth Translational Research Institute, Orlando, Florida
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Harrington J. Anti-obesity medications in the management of heart failure with preserved ejection fraction: available evidence and next STEPS. Heart Fail Rev 2024:10.1007/s10741-024-10410-0. [PMID: 38965119 DOI: 10.1007/s10741-024-10410-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/17/2024] [Indexed: 07/06/2024]
Abstract
Obesity is associated with an increased risk of incident heart failure with preserved ejection fraction (HFpEF) and, among patients with existing heart failure, is associated with worse quality of life, higher symptom burden, and more HF hospitalizations. Anti-obesity medication (AOM) semaglutide has been shown to be efficacious at both causing intentional weight loss and improving HF symptom burden, with some evidence to suggest that HF clinical events may also be reduced. Additional ongoing trials of AOM in patients with cardiovascular disease, including HFpEF, will further improve insight into the potential role of managing obesity to improve HF status among patients with HFpEF and obesity.
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Affiliation(s)
- Josephine Harrington
- Division of Cardiology, Department of Internal Medicine, Duke University Medical Center, Durham, NC, USA.
- Duke Clinical Research Institute, 300 W. Morris St, Durham, NC, 27701, USA.
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Bayes-Genis A. NT-proBNP: Lower Is Always Better-Even in HFpEF. JACC. HEART FAILURE 2024:S2213-1779(24)00493-1. [PMID: 39023489 DOI: 10.1016/j.jchf.2024.05.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Accepted: 05/31/2024] [Indexed: 07/20/2024]
Affiliation(s)
- Antoni Bayes-Genis
- Heart Institute, Hospital Universitari Germans Trias I Pujol, Badalona, CIBERCV, Spain.
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Hathaway JT, Shah MP, Hathaway DB, Zekavat SM, Krasniqi D, Gittinger JW, Cestari D, Mallery R, Abbasi B, Bouffard M, Chwalisz BK, Estrela T, Rizzo JF. Risk of Nonarteritic Anterior Ischemic Optic Neuropathy in Patients Prescribed Semaglutide. JAMA Ophthalmol 2024:2820255. [PMID: 38958939 PMCID: PMC11223051 DOI: 10.1001/jamaophthalmol.2024.2296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 05/08/2024] [Indexed: 07/04/2024]
Abstract
Importance Anecdotal experience raised the possibility that semaglutide, a glucagon-like peptide 1 receptor agonist (GLP-1 RA) with rapidly increasing use, is associated with nonarteritic anterior ischemic optic neuropathy (NAION). Objective To investigate whether there is an association between semaglutide and risk of NAION. Design, Setting, and Participants In a retrospective matched cohort study using data from a centralized data registry of patients evaluated by neuro-ophthalmologists at 1 academic institution from December 1, 2017, through November 30, 2023, a search for International Statistical Classification of Diseases and Related Health Problems, Tenth Revision code H47.01 (ischemic optic neuropathy) and text search yielded 16 827 patients with no history of NAION. Propensity matching was used to assess whether prescribed semaglutide was associated with NAION in patients with type 2 diabetes (T2D) or overweight/obesity, in each case accounting for covarying factors (sex, age, systemic hypertension, T2D, obstructive sleep apnea, obesity, hyperlipidemia, and coronary artery disease) and contraindications for use of semaglutide. The cumulative incidence of NAION was determined with the Kaplan-Meier method and a Cox proportional hazards regression model adjusted for potential confounding comorbidities. Data were analyzed from December 1, 2017, through November 30, 2023. Exposures Prescriptions for semaglutide vs non-GLP-1 RA medications to manage either T2D or weight. Main Outcomes and Measures Cumulative incidence and hazard ratio of NAION. Results Among 16 827 patients, 710 had T2D (194 prescribed semaglutide; 516 prescribed non-GLP-1 RA antidiabetic medications; median [IQR] age, 59 [49-68] years; 369 [52%] female) and 979 were overweight or obese (361 prescribed semaglutide; 618 prescribed non-GLP-1 RA weight-loss medications; median [IQR] age, 47 [32-59] years; 708 [72%] female). In the population with T2D, 17 NAION events occurred in patients prescribed semaglutide vs 6 in the non-GLP-1 RA antidiabetes cohort. The cumulative incidence of NAION for the semaglutide and non-GLP-1 RA cohorts over 36 months was 8.9% (95% CI, 4.5%-13.1%) and 1.8% (95% CI, 0%-3.5%), respectively. A Cox proportional hazards regression model showed higher risk of NAION for patients receiving semaglutide (hazard ratio [HR], 4.28; 95% CI, 1.62-11.29); P < .001). In the population of patients who were overweight or obese, 20 NAION events occurred in the prescribed semaglutide cohort vs 3 in the non-GLP-1 RA cohort. The cumulative incidence of NAION for the semaglutide vs non-GLP-1 RA cohorts over 36 months was 6.7% (95% CI, 3.6%-9.7%) and 0.8% (95% CI, 0%-1.8%), respectively. A Cox proportional hazards regression model showed a higher risk of NAION for patients prescribed semaglutide (HR, 7.64; 95% CI, 2.21-26.36; P < .001). Conclusions and Relevance This study's findings suggest an association between semaglutide and NAION. As this was an observational study, future study is required to assess causality.
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Affiliation(s)
- Jimena Tatiana Hathaway
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston
- Neuro-Ophthalmology Service, Massachusetts Eye and Ear, Harvard Medical School, Boston
| | - Madhura P. Shah
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston
- Neuro-Ophthalmology Service, Massachusetts Eye and Ear, Harvard Medical School, Boston
| | - David B. Hathaway
- Department of Psychiatry, Brigham and Women’s Hospital, Boston, Massachusetts
| | | | - Drenushe Krasniqi
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston
- Neuro-Ophthalmology Service, Massachusetts Eye and Ear, Harvard Medical School, Boston
| | - John W. Gittinger
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston
- Neuro-Ophthalmology Service, Massachusetts Eye and Ear, Harvard Medical School, Boston
| | - Dean Cestari
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston
- Neuro-Ophthalmology Service, Massachusetts Eye and Ear, Harvard Medical School, Boston
| | - Robert Mallery
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston
- Neuro-Ophthalmology Service, Massachusetts Eye and Ear, Harvard Medical School, Boston
| | - Bardia Abbasi
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston
- Neuro-Ophthalmology Service, Massachusetts Eye and Ear, Harvard Medical School, Boston
| | - Marc Bouffard
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston
- Neuro-Ophthalmology Service, Massachusetts Eye and Ear, Harvard Medical School, Boston
| | - Bart K. Chwalisz
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston
- Neuro-Ophthalmology Service, Massachusetts Eye and Ear, Harvard Medical School, Boston
| | - Tais Estrela
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston
- Neuro-Ophthalmology Service, Massachusetts Eye and Ear, Harvard Medical School, Boston
| | - Joseph F. Rizzo
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston
- Neuro-Ophthalmology Service, Massachusetts Eye and Ear, Harvard Medical School, Boston
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Mollan SP. Semaglutide and Nonarteritic Anterior Ischemic Optic Neuropathy. JAMA Ophthalmol 2024:2820264. [PMID: 38958953 DOI: 10.1001/jamaophthalmol.2024.2514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/04/2024]
Affiliation(s)
- Susan P Mollan
- Birmingham Neuro-Ophthalmology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
- Translational Brain Science, Institute of Metabolism and Systems Research, University of Birmingham, Edgbaston, United Kingdom
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Miao M, Yang Y, Dai H. Current research status and future prospects of NLRP3 inflammasome in cardiovascular diseases: a bibliometric and visualization analysis. Front Cardiovasc Med 2024; 11:1407721. [PMID: 39022620 PMCID: PMC11253129 DOI: 10.3389/fcvm.2024.1407721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 06/13/2024] [Indexed: 07/20/2024] Open
Abstract
Background Cardiovascular disease (CVD) is a leading cause of global mortality, with atherosclerosis (AS) contributing to its pathological basis. Inflammation plays a critical role in the pathophysiological process of AS, and the NOD-like receptor protein 3 (NLRP3) inflammasome has been extensively studied in this context. This study aimed to analyze the research status of the NLRP3 inflammasome in cardiovascular disease and provide research directions for further exploration in this field. Methods Using the "Bibliometrix" and "CiteSpace" software, a total of 516 articles were retrieved from the Web of Science (WoS) database published between 2012 and 2023. The search query used the keywords "["CVD" OR "cardiovascular disease"] AND ["NLRP3 inflammasome "OR "NLRP3"]". Visual analysis was performed on authors, countries, institutions, journal sources, keywords, references, and future trends. Results A total of 516 English articles were retrieved, showing an overall upward trend in annual publication volume with slight fluctuations. China, the United States, and Europe were the countries and regions with the highest number of published articles. Among them, China had the highest article count (170), while the United States had the highest citation count (18,664), centrality score (0.43), and h-index (90), indicating its influential role in this research area. These countries also possessed elite institutions, professional researchers, and high-impact journals, making them leading contributors in this field. The main pathogenic mechanisms of the NLRP3 inflammasome in CVD were identified as "oxidative stress", "pyroptosis", and "inflammation". The most frequently studied signaling pathways included "NF-κB", "IL-1", and "C-reactive protein". The most studied disease types were coronary heart disease, atherosclerosis, metabolic syndrome, and myocardial infarction. Additionally, research on the correlation between cholesterol markers and inflammatory indicators associated with NLRP3 inflammasome in CVD risk assessment has gained significant momentum, with the main mechanism being NLRP3/IL-6/hs-CRP and cholesterol lipoproteins emerging as a major keyword in this context. Conclusion This study provides valuable insights into the research hotspots and emerging trends of the NLRP3 inflammasome in cardiovascular disease. The findings offer guidance for researchers and scholars in this field and facilitate the exploration of new research directions.
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Affiliation(s)
- Meiqi Miao
- Department of Cardiology, The First Affiliated Hospital of Heilongjiang University of Traditional Chinese Medicine, Harbin, China
| | - Yuanyuan Yang
- Department of Acupuncture, Dongzhimen Hospital, Beijing University of Traditional Chinese Medicine, Beijing, China
| | - Hailong Dai
- Department of Cardiology, Yan'an Affiliated Hospital of Kunming Medical University, Kunming, China
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Kattah AG, Rule AD. Does Our Classification System for CKD Serve the US Population Well? J Am Soc Nephrol 2024:00001751-990000000-00358. [PMID: 38954468 DOI: 10.1681/asn.0000000000000433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/04/2024] Open
Affiliation(s)
- Andrea G Kattah
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota
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Laddu D, Neeland IJ, Carnethon M, Stanford FC, Mongraw-Chaffin M, Barone Gibbs B, Ndumele CE, Longenecker CT, Chung ML, Rao G. Implementation of Obesity Science Into Clinical Practice: A Scientific Statement From the American Heart Association. Circulation 2024; 150:e7-e19. [PMID: 38766861 DOI: 10.1161/cir.0000000000001221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
Obesity is a recognized public health epidemic with a prevalence that continues to increase dramatically in nearly all populations, impeding progress in reducing incidence rates of cardiovascular disease. Over the past decade, obesity science has evolved to improve knowledge of its multifactorial causes, identifying important biological causes and sociological determinants of obesity. Treatments for obesity have also continued to develop, with more evidence-based programs for lifestyle modification, new pharmacotherapies, and robust data to support bariatric surgery. Despite these advancements, there continues to be a substantial gap between the scientific evidence and the implementation of research into clinical practice for effective obesity management. Addressing barriers to obesity science implementation requires adopting feasible methodologies and targeting multiple levels (eg, clinician, community, system, policy) to facilitate the delivery of obesity-targeted therapies and maximize the effectiveness of guideline-driven care to at-need patient populations. This scientific statement (1) describes strategies shown to be effective or promising for enhancing translation and clinical application of obesity-based research; (2) identifies key gaps in the implementation of obesity science into clinical practice; and (3) provides guidance and resources for health care professionals, health care systems, and other stakeholders to promote broader implementation and uptake of obesity science for improved population-level obesity management. In addition, advances in implementation science that hold promise to bridge the know-do gap in obesity prevention and treatment are discussed. Last, this scientific statement highlights implications for health research policy and future research to improve patient care models and optimize the delivery and sustainability of equitable obesity-related care.
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