Obesity is a major cause of illness and death, mainly due to cardiovascular disease (CVD), which claims about 18 million deaths each year. New anti-obesity medications (AOMs) are now being used both experimentally and clinically to manage this growing threat to public health. A recent study published in the journal Obesity explores the impact of these new drugs on CVD among obese individuals. Study: The association between weight loss medications and cardiovascular complications. Image Credit: Douglas Cliff / Shutterstock.com What are AOMs? Although AOMs have been approved to manage obesity, the current study used real-world data to evaluate their effects on different cardiovascular conditions. Clinical trials suggest that AOMs, including semaglutide and tirzepatide, can mitigate the incidence of CVD in people with excessive body weight. Both semaglutide and tirzepatide are glucagon-like peptide 1 (GLP-1) inhibitors originally approved for controlling glucose levels and have since been shown to effectively induce weight loss. While semaglutide received approval in 2017, its ability to induce weight loss of up to 15% of body weight led to the development and approval of Wegovy, an anti-obesity drug approved in 2021 for long-term management of body weight. Tirzepatide was approved in 2022 and subsequently investigated for its impact on weight loss. To this end, tirzepatide has been shown to induce up to 20% weight loss, which led to its approval in 2023 for this indication. The current study included obese patients on Medicare who were 65 years old or older. In this patient population, at least one in two have one or more heart conditions and, as a result, require twice as high health costs as those without cardiac disease. This has led to a reconsideration of the feasibility and effectiveness of including AOMs under Medicare coverage. About the study The current retrospective study compares cardiovascular outcomes among Medicare patients with obesity treated with newly approved AOMs from 2020 to 2022. The study included nearly 6,000 patients receiving semaglutide or tirzepatide and 79,000 controls. While the average age was slightly lower in the AOM cohort, this cohort had a higher comorbidity score of two or more and was more likely to have a low socioeconomic status (SES). The AOM cohort also had a higher prevalence of hypertension, 72%, as compared to 61% among controls, as well as type 2 diabetes and hyperlipidemia, at about 65% and 40%, respectively, as compared to 25% and 30%, respectively. Most patients received Ozempic (semaglutide), while 375 and 147 patients were prescribed Wegovy and Mounjaro (tirzepatide), respectively. The most common illnesses among these patients were hypertension, type 2 diabetes, and high blood lipid levels. What did the study show? Patients treated with AOMs had an 8% reduced risk of heart failure and other cardiovascular complications. The effect was strongest among patients aged 71 to 80, at a 33% reduction in risk compared to those between 65 and 70. Comparatively, patients at least 80 years of age were at twice the risk than those between 65 and 70. Females were at a 26% reduced risk of CVD than males, whereas residents from low and medium SES areas were at a higher risk than those from high SES areas. The use of AOMs protected against CVD during the first year of use but not longer. Younger female individuals had a lower risk throughout the 1,000-day period; however, those with higher comorbidity scores had a stable increased CVD risk. Hyperlipidemia was associated with a reduced CVD risk over the first three months and from 720 to 960 days, after which the risk increased. This may be an artifact, as hyperlipidemia may have been being treated and subsequently improved patient prognoses. Smoking was associated with an increased risk of CVD and chronic kidney disease for the first 660 days. The incidence of heart failure was 4.9% as compared to 6.1% in untreated patients. Similarly, atrial fibrillation occurred in 3.8% of AOM recipients as compared to 5.1% of untreated patients. The incidence of peripheral vascular disease declined from 3.44% to 2.9% in the two groups, whereas arrhythmias occurred in 3.6% and 4.1% of treated and untreated patients, respectively. Overall, the risk of any CVD events was reduced by 8%. Conclusions The use of AOMs in obese patients reduces the risk of CVD by decreasing the prevalence of this modifiable risk factor. Previous studies have established that losing 5-10% of body weight is an effective way to improve blood glucose control, blood pressure, and blood lipid levels in a dose-dependent manner. Future studies are needed to elucidate the mechanism of weight loss associated with AOMs, the effect of lowering the cost of access to AOMs among this population, and the impact on CVD. Journal reference: Baser, O., Samayoa, G., Rodchenko, K., et al . (2024). The association between weight loss medications and cardiovascular complications. Obesity . doi:10.1002/oby.24037.
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