A new expert consensus statement issued by the American College of Cardiology said that cardiologists should “embrace” new weight-loss medications for patients with obesity, TCTMD reported June 25.
Here are 10 takeaways from the report:
1. The experts said that, while lifestyle changes are the “foundation” of obesity management, failure of patients to fully implement lifestyle changes should not be the trigger for utilizing weight-loss medications, including GLP-1s, in their treatment.
2. “We have to recognize [obesity] as a risk factor for cardiovascular disease and recognize it as its own chronic disease,” Martha Gulati, MD, a cardiologist at Cedars-Sinai Medical Center in Los Angeles, told TCTMD. “It’s not that lifestyle doesn’t work. It does work in some patients, but the problem is adhering to it. Long-term has always been a challenge. Even the amount of weight loss that you get with lifestyle, particularly for people with severe obesity, is not enough to lower cardiovascular risk.”
3. The consensus statement is not a guideline recommendation, but aims to help inform cardiologists about a group of medications that are “relatively new for them,” according to TCTMD, and to encourage physicians to become more involved in the management of obesity. It is also intended to help cardiologists refer patients to physicians who may be more appropriate for managing weight loss.
4. The consensus statement also outlines the complex causes of obesity and some of the risks it presents to cardiovascular health, including atherosclerotic cardiovascular disease, heart failure, atrial fibrillation, sudden cardiac death, venous thromboembolism and valvular heart disease.
5. It also outlined the eligibility and rationale for weight-loss medication as a treatment for obesity, including the use of newly approved drugs, including GLP-1s, receptor agonists semaglutide like Wegoby and Novo Nordisk, and other similar medications.
6. The statement also included a review of the evidence supporting the use of other new medications, including liraglutide in patients with obesity, Type 2 diabetes and cardiovascular disease, or those who are at high risk for cardiovascular disease. For patients without diabetes, semaglutide is the only medication shown to reduce the risk of major adverse cardiovascular events, while an ongoing Surmount-MMO trial is currently testing tirzepatide for cardiovascular disease event reduction in overweight people with established disease.
7. Dr. Gulati also noted that the treatment of obesity is changing rapidly. At the recent American Diabetes Association’s 85th Scientific Sessions in Chicago, numerous studies showed the effectiveness of “newer agents” — some in combination with other therapies — in reducing body weight in patients with and without diabetes. While none of these “newer agents” are FDA-approved, the evidence supporting their use is growing overnight, Dr. Gulati said.
8. Changes in lifestyle typically result in a 5% reduction in body weight and improvements in triglycerides, blood pressure and fasting glucose levels, according to TCTMD. But newer GLP-1 and GLP-1/GIP agents have been shown to reduce body weight by 15% and 20%, respectively, while metabolic surgery remains the most effective weight-loss tool.
9. Ultimately, management of obesity should be multifaceted, according to the consensus statement, with coordinated care to address modifiable risk factors, potential comorbidities and to tailor therapies. A 5% reduction in body weight should be a goal for reducing CVD risk factors and preventing incident disease. Weight loss medications can be scaled back as needed, but “long-term treatment should be the default plan,” according to the statement.
10. “I think we’ve given [cardiologists] tools that they can use or refer to experts if they’re not comfortable,” said Dr. Gulati. “There may be some subspecialists in cardiology who may still feel like they’re not comfortable enough yet with these drugs, but knowing that they’re indicated and who they’re indicated for will help them in their practice, whether it’s referring [patients] to a preventive cardiologist or an obesity specialist.”
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