Obesity Treatments
Hyperbole is almost impossible when describing the potential benefits of the glucagon-like peptide-1 (GLP-1) receptor agonists. Obesity is that big of a problem.
The biggest breakthrough of the year for this drug class came in the SELECT trial. Semaglutide reduced cardiovascular outcomes in patients with established cardiovascular disease and obesity but without diabetes. SELECT turned semaglutide into a cardiac drug.
Two meta-analyses suggested that the dual GLP-1a and glucose-dependent insulinotropic polypeptide (GIP) receptor agonist tirzepatide is the more potent weight-reducing agent, but the sure-to-come cardiovascular indication will probably make semaglutide more popular, at least initially. I'd bet on a class effect regarding cardiac protection.
The placebo-controlled STEP-HFpEF trial of semaglutide in patients with obesity and heart failure with preserved ejection fraction (HFpEF) was unblinded and too small to conclude much about outcomes but at least hinted at safety in HFpEF.
Downsides include gastrointestinal intolerance and costs. And the just-published results of the SURMOUNT-4 withdrawal trial underscores the challenge of weight regain when the drugs are stopped.
This drug class may be the biggest story in medicine of the past 10 years.
The Sobering Results of the RCT Duplicate Project
I have often argued that one of the greatest innovations of modern medicine has been the randomized controlled trial (RCT).
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COMMENTARY
Mandrola's Top 10 Cardiology Stories of 2023
John M. Mandrola, MD
DisclosuresDecember 20, 2023
Obesity Treatments
Hyperbole is almost impossible when describing the potential benefits of the glucagon-like peptide-1 (GLP-1) receptor agonists. Obesity is that big of a problem.
The biggest breakthrough of the year for this drug class came in the SELECT trial. Semaglutide reduced cardiovascular outcomes in patients with established cardiovascular disease and obesity but without diabetes. SELECT turned semaglutide into a cardiac drug.
Two meta-analyses suggested that the dual GLP-1a and glucose-dependent insulinotropic polypeptide (GIP) receptor agonist tirzepatide is the more potent weight-reducing agent, but the sure-to-come cardiovascular indication will probably make semaglutide more popular, at least initially. I'd bet on a class effect regarding cardiac protection.
The placebo-controlled STEP-HFpEF trial of semaglutide in patients with obesity and heart failure with preserved ejection fraction (HFpEF) was unblinded and too small to conclude much about outcomes but at least hinted at safety in HFpEF.
Downsides include gastrointestinal intolerance and costs. And the just-published results of the SURMOUNT-4 withdrawal trial underscores the challenge of weight regain when the drugs are stopped.
This drug class may be the biggest story in medicine of the past 10 years.
The Sobering Results of the RCT Duplicate Project
I have often argued that one of the greatest innovations of modern medicine has been the randomized controlled trial (RCT).
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Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.
Cite this: Mandrola's Top 10 Cardiology Stories of 2023 - Medscape - Dec 20, 2023.
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Authors and Disclosures
Authors and Disclosures
Author
John M. Mandrola, MD
Clinical Electrophysiologist, Baptist Medical Associates, Louisville, Kentucky
Disclosure: John M. Mandrola, MD, has disclosed no relevant financial relationships.