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Welcome back to the CardioNerds Cardiovascular Prevention Series, where we are continuing our discussion of Glucagon-like Peptide-1 Receptor Agonists (GLP-1 RAs). This class of medications is becoming a household name, not only for their implications for weight loss but also for their effect on cardiovascular disease. CardioNerds Dr. Ty Sweeney (CardioNerds Academy Faculty Member and incoming Cardiology Fellow at Boston Medical Center), Dr. Rick Ferraro (CardioNerds Academy House Faculty and Cardiology Fellow at Johns Hopkins Hospital), and special guest Dr. Franck Azobou (Cardiology Fellow at UT Southwestern) sat down with Dr. Darren McGuire (Cardiologist at UT Southwestern and Senior Editor of Diabetes and Vascular Disease Research) to discuss important trial data on GLP-1 RAs in patients with heart disease, as well as recent professional society guidelines on their use. Show notes were drafted by Dr. Ty Sweeney. Audio editing was performed by CardioNerds Intern student Dr. Diane Masket.
If you haven’t already, be sure to check out CardioNerds episode #350 where we discuss the basics and mechanism of action of GLP-1 RAs with Dr. Dennis Bruemmer.
This episode was produced in collaboration with the American Society of Preventive Cardiology (ASPC) with independent medical education grant support from Novo Nordisk. See below for continuing medical education credit.
Claim CME for this episode HERE.
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Pearls and Quotes - GLP-1 Agonists: Diving into the Data
Patients with diabetes and clinical atherosclerotic cardiovascular disease (ASCVD) or who are at high risk of ASCVD benefit from treatment with a GLP-1 RA.
For persons with sufficient ASCVD risk and type 2 diabetes, GLP-1 RAs and SGLT2 inhibitors can, and often should, be used in combination. "Just like we don’t consider ‘and/or’ for the four pillars of guideline-directed medical therapy for heart failure with reduced ejection fraction, we shouldn’t parcel out these two therapeutic options...it should be both.”
Setting expectations with your patients regarding injection practices, side effects, and expected benefits can go a long way toward improving the patient experience with GLP-1 RAs.
Utilize a multidisciplinary approach when caring for patients on GLP-1 RAs. Build a team with your patient’s primary care provider, endocrinologist, clinical pharmacist, and nurse.
“This is really a cardiologist issue. These are no longer endocrinology or primary care drugs. We need to be prescribing them ourselves just like we did back in the nineties when we took over the statin prescriptions from the endocrinology domain...we need to lead the way.”
Show notes - GLP-1 Agonists: Diving into the Data
For which patients are GLP-1 RAs recommended to reduce the risk of major cardiac events?
For patients with type 2 diabetes and ASCVD, starting a GLP-1 RA carries a Class 1, Level of Evidence A recommendation in the most recent ESC and ACC guidelines.
For patients without diabetes or clinical ASCVD with an estimated 10-year risk of CVD exceeding 10%, consideration of starting a GLP-1 RA carries a Class 2b, Level of Evidence C recommendation to reduce CV risk.
The STEP-HFpEF trial showed that among patients with obesity and HFpEF, once-weekly semaglutide may be beneficial in terms of weight loss and quality of life.
The results of the FIGHT and LIVE trials question the utility and safety of liraglutide in treating patients with advanced HFrEF. Of the over 17,000 patients enrolled in the SELECT trial, about 25% had heart failure, of which about one-third had HFrEF. Stay tuned for sub-analyses from that trial for more info!
Can we still prescribe GLP-1 Ras in patients with well-controlled T2DM?
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Max Keto Gummies have been gaining popularity in recent months as more people are turning to keto-friendly supplements to help them achieve their weight loss goals. These gummies are designed to help support ketosis, which is the state in which your body burns fat for fuel instead of carbohydrates. In this article, we will take an in-depth look at Max Keto Gummies to help you determine if they are the right supplement for you.
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Before taking any supplement, it is important to read the ingredient list to ensure that you are not allergic to any of the components. If you have any concerns about the ingredients in Max Keto Gummies, it is recommended to consult with your healthcare provider before taking them.
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Max Keto Gummies work by providing your body with the nutrients it needs to stay in ketosis. When you follow a ketogenic diet, your body switches from using carbohydrates for fuel to using fat. This transition can be challenging for some people, which is where keto supplements like Max Keto Gummies come in.
By taking these gummies daily, you can help support your body’s ability to stay in ketosis and burn fat for fuel. The ingredients in Max Keto Gummies work together to provide your body with the energy it needs to function optimally while on the keto diet.
It is important to note that Max Keto Gummies are not a magic solution for weight loss. They should be used in conjunction with a healthy diet and exercise routine to see the best results. Consistency is key when it comes to reaching your weight loss goals with the help of Max Keto Gummies.
Benefits
There are several potential benefits to taking Max Keto Gummies as part of your ketogenic diet regimen. One of the main benefits is that these gummies can help support your body’s ability to enter and stay in ketosis, which is essential for burning fat for fuel.
In addition to supporting ketosis, Max Keto Gummies may also help curb cravings and reduce appetite, making it easier to stick to your ketogenic diet. The ingredients in these gummies can also help provide a boost of energy, making it easier to stay active and maintain your exercise routine.
Other potential benefits of Max Keto Gummies include improved mental clarity and focus, as well as better digestion and gut health. These gummies are a convenient way to get the support you need while following a ketogenic diet.
Side Effects
While Max Keto Gummies are generally safe for most people, there are some potential side effects to be aware of. Some people may experience digestive issues such as bloating, gas, or diarrhea when first starting to take these gummies.
It is important to start with a small dosage of Max Keto Gummies and gradually increase your intake to assess how your body reacts. If you experience any negative side effects, it is recommended to discontinue use and consult with your healthcare provider.
If you have any underlying health conditions or are pregnant or breastfeeding, it is recommended to speak with your healthcare provider before taking Max Keto Gummies. It is always best to err on the side of caution when it comes to taking supplements, especially if you have any preexisting health concerns.
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Weight loss drugs can be a helpful tool for individuals struggling to lose weight, especially when lifestyle changes alone aren't enough. These medications work by suppressing appetite, increasing metabolism, or blocking the absorption of fat. However, they are typically recommended in combination with a healthy diet and exercise. It’s important to consult a healthcare professional before using weight loss drugs to ensure they are safe and appropriate for your specific health needs. Some common options include prescription medications like Orlistat, Phentermine, and newer treatments like GLP-1 agonists.
