The future of treatments for the management of obesity in the reduction of cardiovascular risks

With the ever-growing obesity epidemic in the United States, there are many approaches to continue to properly counsel patients on obesity management, including surgery, diets and medications, according to a session presented at the American College of Cardiology 2022 Scientific Sessions.

Domenica Rubino, MD, began the session by discussing GLP-1 receptor agonists for weight loss and the goal of healthcare professionals to close the gap in this area and help more patients avoid surgery.

Rubino provided insight into the role of GLP-1s, which can dramatically reduce food intake and energy intake in the brain. Specifically, agonists act as a signal from the gastrointestinal tract in response to food and affect appetite and regulation while acting as a neurotransmitter.

Rubino noted that incorporating exercise into lifestyle changes is very important when putting a patient on medication because it will not only improve an individual’s weight, but also their cardio risk. -embolic. She highlighted how semaglutide is the next generation of medical therapy and can move healthcare professionals into the future of weight loss.

“Semaglutide takes us to a much higher degree of weight loss,” Rubino said.

Regarding non-GLP1 therapies for weight loss, Jamie Kane, MD, director of the Northwell Health Center for Weight Management, explained that although the same drugs have been used for weight loss for a number of years, there is still a larger picture surrounding cardiovascular disease. risk.

He shared how these drugs have 4 mechanisms for each patient: reduce calorie consumption/absorption, increase energy expenditure, improve insulin sensitivity and increase fatty acid oxidation/reduce lipogenesis. No drug can have all 4 reactions, with Kane sharing that 2 or 3 occur in every patient.

Weight-loss drugs such as orlistat and phentermine are the most commonly prescribed; However, Kane noted that other medications can thwart weight loss, such as psychiatric or antiepileptic drugs, diabetes medications, corticosteroids, beta-blockers, antihistamines, and hormone manipulation. Considering these factors before counseling a patient can help direct them to other diabetes alternatives, such as metformin and DPP4, which are considered the “gold standard,” according to Kane.

Diets and diets can be complicated for patients, and according to Danielle Belardo, MD, preventive cardiologist, the key is to reduce risk factors for atherosclerotic cardiovascular disease, which are hyperlipidemia, diabetes, hypertension and l smoking cessation/obesity/exercise, while considering each patient we counsel.

“We can’t beat general physics, so all calorie deficit diets result in weight loss regardless,” Belardo said.

Durability is what lasts with each patient’s weight loss journey, and Belardo mentioned some examples of clinical trials that have explored this concept, such as the CALERIE, POUNDS, and Look Ahead trials. Each of them looked at different lifestyle modifications, calorie deficits, or exercise techniques to further determine what helps patients maintain a healthier lifestyle.

Overall, Belardo emphasized that healthcare professionals need to meet their patients at their health level and find a regimen that works for them to best reduce the risk of cardiovascular events. Additionally, it means considering all the social determinants of health, such as access to food and food security, that might affect their journey.

“We recommend doing this in a way that is helpful to the patient and helps them achieve their goals, and there are many ways to do this without a patient feeling too limited in their diet,” said said Belardo.

Finally, Sean Heffron, MD, MS, MSc, discussed surgical approaches to obesity and how modern bariatric surgery can improve cardiovascular outcomes. He explained that although there are lower rates of cardiovascular outcomes in every surgery group that has been studied in the past, the type of surgery that is performed is important in terms of weight loss for each patient.

Additionally, Heffron described how bariatric surgery can reduce the risk of cardiovascular disease (CVD) beyond expectation and offer resolution of only obesity-associated CVD risk factors.

While these surgeries are effective, Heffron pointed out how underutilized they are due to the fact that only 15% of the obese population gets the proper referral from a doctor. This also includes men, Hispanics, non-whites, and low-income populations who don’t get enough attention early enough to get the right treatment for their weight loss goals.

“Our lack of notice and referral to bariatric surgeons is likely part of this shortcoming,” Heffron added.

Heffron concluded that bariatric surgeries improve many obesity-related comorbidities and have many other underestimated effects for a lower risk of cardiovascular problems.

REFERENCE

Beyond Lifestyle: Next Steps in Obesity Management. ACC 2022. April 2, 2022. Accessed April 2, 2022.