Exploring the Cardiovascular Benefits of GLP-1 RAs in Patient Care
Exploring the Cardiovascular Benefits of GLP-1 RAs in Patient Care
— By Dawn M. Sweet, Ph.D.
When a GLP-1 medication is added to the treatment plan of patients with type 2 diabetes, cardiovascular outcomes improve.
The role of GLP-1 receptor agonists (GLP-1 RAs) is expanding beyond glycemic control and weight loss, emerging as a promising therapeutic option with proven cardiovascular benefits. Several recent GLP-1 cardiovascular trials (CVOT) have found evidence for GLP-1 ability to reduce the risk of major cardiovascular events (MACE) and providing cardiovascular benefits for patients with type 2 diabetes.
GLP-1 Cardiovascular Outcome Trials (CVOT)
Several clinical trials have investigated the benefits of GLP-1 RAs for cardiovascular outcomes.
The Evaluation of Lixisenatide in Acute Coronary Syndrome (ELIXA) clinical trial was a multicenter, randomized, double-blind, placebo-controlled trial with 6,068 patients with type 2 diabetes wherein the effects of lixisenatide on CV morbidity and mortality were investigated.1
Participants were randomized into the lixisenatide group (n = 3,034) with a 10μg daily starting dose and control group (n = 3,034). After two weeks, the dose increased to 20 μg at the discretion of the investigator. The primary endpoint was the initial occurrence of death from CVD causes, non-fatal stroke, non-fatal MI, or hospitalization for unstable angina. Results from this study found that lixisenatide was not associated with a significant difference in cardiovascular events. Lixisenatide did not show superiority to the placebo.
Both the LEADER and SUSTAIN clinical trials found evidence to support a reduction in cardiovascular risk in adults with type 2 diabetes. The LEADER clinical trial was a double-blind, placebo-controlled, even- and time-driven trial with a 42-60 month follow up.2 Participants with type 2 diabetes and an elevated risk for cardiovascular disease were randomized into a liraglutide (n = 4,668; 1.8mg or maximum tolerated dose) group and a control group (n = 4,672). The time-to-event analysis showed that in the liraglutide group, the rate of the first occurrence of death from cardiovascular causes, nonfatal MI, or nonfatal stroke was lower in the liraglutide group.
In the SUSTAIN 6 clinical trial,3 patients with type 2 diabetes and a high CV risk (N = 3,297) were randomized into 0.5mg or 1.0mg once-weekly dose of subcutaneous semaglutide. Across 104 weeks, 6.6 percent of participants in the semaglutide group reported a major adverse cardiac event (MACE) compared with 8.9 percent in the control group. It’s noted that this study was not powered to demonstrate superiority, although the treatment effect of subcutaneous semaglutide resulted in a nominally smaller risk of MACE.
Across several CVOTs that included patients with type 2 diabetes, results clearly indicate a reduction in cardiovascular morbidity and mortality when a GLP-1 RA is used.4 GLP-1 RAs have also demonstrated benefits for lower systolic blood pressure of 2 to 6 mm Hg.5 GLP-1 RAs have also been associated with modest reductions in total cholesterol, LDL cholesterol, and triglycerides.6 Based on results from several CVOTs, the 2019 European Society of Cardiology7 guidelines on diabetes, prediabetes, and CVD now recommend using a GLP-1 RA for patients with type 2 diabetes and atherosclerotic cardiovascular disease, and a 2020 report from the American College of Cardiology Solution Set Oversight Committee recommends adding a GLP-1 RA for patients with type 2 diabetes and elevated risk for atherosclerotic cardiovascular disase.8
Practical Implications for Health Care Providers
GLP-1 RAs have cardiovascular benefits, with evidence suggesting there are improvements in cardiovascular markers like blood pressure, cholesterol, and initial onset of a major adverse cardiovascular event. For patients with type 2 diabetes, cardiovascular disease presents a substantial risk, so adding a GLP-1 RA as part of the treatment plan for patients with type 2 diabetes could add additional protection against cardiovascular risks. GLP-1 RAs demonstrate clear and measurable benefits relative to improving cardiovascular outcomes. Given the cardiovascular benefits of GLP-1 RAs, health care providers should talk with their patients about adding a GLP-1 RA as part of their treatment program when there is an elevated risk for a major adverse cardiovascular event.
In addition, scientifically formulated meal replacements offer health care providers with a valuable nonpharmacological treatment option for patients at risk of cardiovascular disease. Meal replacements can complement GLP-1 therapies, supporting healthy nutrition and preserving muscle mass during active weight loss.
Source(s):
1 Lixisenatide in patients with type 2 diabetes and acute coronary syndrome
2 Liraglutide and cardiovascular outcomes in type 2 diabetes
7 European Society of Cardiology: Cardiovascular disease statistics 2019
About the Author: Dr. Dawn M. Sweet has over 20 years of experience in the field of communication. Dr. Sweet has given several invited talks to and workshops for academic and private sector audiences on the role of nonverbal and verbal communication in achieving positive outcomes and mitigating bias. Her research has been published in several top ranked peer-review journals, and it has been featured on NPR’s River to River / All Things Considered, Buzzfeed, and Science Daily. Her research has also been used to inform expert testimony.
About Robard: Robard Corporation’s medical obesity treatment programs and scientifically-designed nutrition products have been utilized by physicians, surgeons and hospitals across the United States to successfully treat patients living with obesity. To learn more about us and how we can help your practice and patients, visit us online at www.Robard.com, email us at info@robard.com, or call (800) 222-9201.
