On April 11-14, 2024, the 25th Southern Conference on Cardiovascular Diseases was held in Guangzhou. During the conference, the "GLP-1 RA Cardiovascular Metabolism Frontier Forum" was grandly held, Professor Jing Zhicheng of Guangdong Provincial People's Hospital, Professor Luo Jianfang of Guangdong Provincial People's Hospital, and Professor Xiang Dingcheng of the Southern Theater General Hospital of the Chinese People's Liberation Army served as the chairman of the conference RA) and other aspects of the application of a series of academic sharing and discussions.
Professor Jing Zhicheng (left) from Guangdong Provincial People's Hospital and Professor Xiang Dingcheng (right) from the Southern Theater General Hospital of the Chinese People's Liberation Army chaired the forum
Hotspot updates
Cardiovascular disease and diabetes management concept change and frontier hot spots
Professor Chen Zhenyue, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine
Professor Zhenyue Chen from Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, introduced the latest international guidelines, scientific statements and new research progress in the field of cardiovascular disease (CVD) and diabetes management. The recently updated 2023 ESC Guidelines for the Management of Cardiovascular Disease in Patients with Diabetes Mellitus, the 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guidelines for the Management of Chronic Coronary Artery Disease, and the 2023 AHA Chair's Recommendations for Cardiovascular-Renal-Metabolic Health reflect the increasing importance of integrated management of multiple risk factors, with a common emphasis on GLP-1 RA plays an important role in the management of cardiovascular disease and diabetes mellitus, and is recommended as a first-line treatment to improve cardiovascular outcomes.
Subsequently, Professor Chen Zhenyue shared the latest research results in the field of cardiovascular disease and diabetes announced in 2023: such as the post-hoc analysis of the SUSTAIN 6 study presented at the 2023 ESC Congress, which aims to evaluate the effect of semaglutide subcutaneous administration on MACE in T2DM patients with different numbers of atherosclerotic lesions. The results showed that subcutaneous administration of semaglutide could significantly reduce the risk of MACE in patients with multi-vessel disease, univascular disease, or T2DM without ASCVD, and the benefit was independent of the number of atherosclerotic vascular lesions in the patient, and the higher the baseline MACE risk, the greater the absolute benefit.
In addition, Professor Chen Zhenyue also introduced the latest review published in Cardiovasc Diabetol, an authoritative journal in the field of cardiometabolic diseases in 2023, which stated that GLP-1 RA and SGLT2 inhibitors synergize the mechanism and combine therapy to further improve blood glucose, weight, Blood pressure and cardiorenal prognosis have important clinical value, and a cohort study of more than 740,000 people published in 2023 showed that long-term use of GLP-1 RA/SGLT2 inhibitors in elderly T2DM populations aged 65 years and older has clear cardiovascular benefits and a favorable safety profile.
Go with all your heart
GLP-1 RA has started a new journey in the treatment of cardiovascular diseases
Professor Wu Pingsheng, Nanfang Hospital, Southern Medical University
Professor Wu Pingsheng from Nanfang Hospital of Southern Medical University started from the mechanism of action of GLP-1 RA and interpreted the cardiovascular benefits of semaglutide: GLP-1 can play multiple roles such as stimulating insulin secretion, antioxidant, improving energy metabolism and cardiovascular protection through three pathways: GLP-1 receptor dependence, non-GLP-1 receptor dependence and receptor independence. GLP-1 and its metabolites can also reduce the lipid core of atherosclerotic plaques, increase the thickness of the fibrous cap, delay the occurrence and progression of atherosclerosis through multiple mechanisms, and act on multiple links in the cardiovascular event chain to reduce the risk of cardiovascular events and death.
Subsequently, Professor Wu interpreted the Cardiovascular Outcome Study (CVOT) of semaglutide - the SUSTAIN-6 study. The results of this study showed that semaglutide could further reduce the risk of MACE in patients with T2DM by 26% and significantly reduce the risk of non-fatal stroke by 39% on the basis of standard treatment (including statins, antiplatelet drugs, angiotensin-converting enzyme inhibitors (ACEI)/angiotensin II receptor antagonists (ARBs)/aldosterone receptor blockers, β receptor blockers, etc. Post-hoc analysis showed that the cardiovascular benefit was independent of age, gender, baseline glycosylated hemoglobin (HbA1c), baseline body mass index (BMI), duration of diabetes, ethnicity, number of coronary artery lesions, and whether there were previously diagnosed cardiovascular diseases.
At the same time, semaglutide can also effectively improve patients' cardiovascular and metabolic risk factors such as blood glucose, BMI, blood lipids, and blood pressure, delay the occurrence and development of atherosclerosis from the source, and bring new hope for early blockade of the cardiovascular event chain!
From the heart
Cardiologists should be the workhorse of cardiometabolic management
Professor Binjianping, Nanfang Hospital, Southern Medical University
Professor Bin Jianping of Nanfang Hospital of Southern Medical University pointed out that the global epidemic of T2DM poses a threat to reducing the burden of cardiovascular diseases, and with the progress of the hypoglycemic drug CVOT, the treatment of T2DM has entered the management scope of cardiovascular doctors. The 2023 review article "Type 2 Diabetes Mellitus: Now in the Cardiologist's Wheelhouse" published in JACC pointed out that T2DM is now also under the management of cardiovascular physicians, calling for the application of GLP-1 RA with clear cardiovascular benefits to the early treatment of cardiometabolic diseases in patients with T2DM as part of routine cardiology practice. Professor Bin called on cardiologists to strengthen the study of T2DM management and clinical medication, and become the main force in cardiometabolic management.
In clinical practice, you can refer to the "Concise Guide to the Application of GLP-1 RA in Cardiology" published in JAMA Cardiology, and start the practice through its recommended five-step approach: selecting applicable objects, screening for contraindications, adjusting other hypoglycemic drugs, monitoring and follow-up matters, and answering patients' questions.
The guidelines clarify the characteristics of patients who are and are not suitable for GLP-1 RA: it is suitable for patients with T2DM with ASCVD or ASCVD risk factors, T2DM with overweight/obesity, and T2DM with advanced diabetic nephropathy; GLP-1 RA is contraindicated in patients with a history or family history of GLP-1 RA allergy, pregnancy or breastfeeding, medullary thyroid carcinoma or type 2 multiple endocrine neoplasia syndrome; and patients with a history of gastroparesis or gastric surgery, pancreatitis, and proliferative diabetic retinopathy should be used with caution.
When patients initiating GLP-1 RA are taking other hypoglycemic drugs at the same time, it is more convenient to adjust other hypoglycemic drugs, and it is convenient to combine them with commonly used drugs: except for dipeptidyl peptidase 4 inhibitors (DPP-4i), which need to be discontinued, insulin and sulfonylureas can be appropriately reduced according to the patient's glycemic control and history of hypoglycemia, while other hypoglycemic drugs do not need to be adjusted. Semaglutide has less interaction with commonly used clinical drugs (eg, atorvastatin, warfarin and other coumarin derivatives, digoxin, paracetamol, oral contraceptives, etc.), so there is no need to adjust the dose.
The most common side effects of GLP-1 RA are mainly gastrointestinal reactions, which are mostly transient and often occur within a few weeks of initiation. You can fully communicate with the patient in advance, start with a low dose, gradually increase the dose, and at the same time eat a small number of meals, slow down the speed of eating, etc., to help the patient better overcome the discomfort in the early stage of use.
Put it into practice
Experience sharing in the management of cardiometabolic diseases and the application of GLP-1 RA
The First Affiliated Hospital of Guangzhou Medical University, Professor Chen Ailan
Professor Chen Ailan from the First Affiliated Hospital of Guangzhou Medical University shared the clinical management experience of cardiometabolic diseases and the application of GLP-1 RA from the case of two patients with cardiovascular diseases such as type 2 diabetes mellitus and other metabolic risk factors. After treatment with semaglutide, the patient's blood pressure, blood glucose, blood lipids, body weight and other metabolic indicators were improved, the condition was effectively controlled, and the quality of life was significantly improved.
Professor Chen Ailan said that the emergence of GLP-1 RA provides a new idea for the clinical management of cardiometabolic diseases. GLP-1 RA has pleiotropic properties, not only has significant cardiovascular benefits, but also lowers blood pressure, regulates blood lipid profile, lowers blood sugar, lowers body weight, improves inflammation, etc., and comprehensively helps to improve cardiometabolic diseases.
Expert interviews
Looking forward to a new future in the management of cardiometabolic diseases
Subsequently, Professor Luo Jianfang from Guangdong Provincial People's Hospital, Professor Li Lang from the First Affiliated Hospital of Guangxi Medical University, Professor Lin Jinxiu from the First Affiliated Hospital of Fujian Medical University, Professor Liu Qiang from Shenzhen Hospital of Traditional Chinese Medicine, Professor Luo Yukun from Union Hospital of Fujian Medical University, and Professor Tan Ning from Guangdong Provincial People's Hospital discussed the initial timing and standardized application of GLP-1 RA, as well as the changes and prospects brought by GLP-1 RA to the management of cardiometabolic diseases.
Professor Li Lang
In recent years, GLP-1 RA/SGLT2 inhibitors have been recommended in major guidelines at home and abroad, which has become a current development trend, therefore, both cardiologists and endocrinologists should consider GLP-1RA/SGLT2 inhibitors as the preferred treatment regimen to achieve comprehensive management of patients with comorbidities.
Prof. Lin Jinxiu
The comprehensive management of cardiometabolic diseases is the key to the prevention and control of cardiovascular diseases, and multidisciplinary integration plays an important role in the prevention and treatment of cardiometabolic diseases. In recent years, the emergence of GLP-1 RA has provided a powerful weapon for the comprehensive clinical management of cardiometabolic diseases.
Prof. Qiang Liu
GLP-1 RA is associated with better short- and long-term outcomes in CVD patients with metabolic disease. In the process of clinical treatment, cardiologists should strengthen doctor-patient communication, conduct adequate medication education for patients, and clearly inform patients that they need to adhere to GLP-1 RA drugs for a long time to obtain long-term cardiovascular protection benefits.
Prof. Yukun Luo
Diabetes mellitus is common in patients with chronic total occlusion (CTO) of the coronary arteries, and patients with diabetes mellitus have a higher incidence of adverse cardiovascular events after percutaneous coronary intervention (PCI) compared with those without diabetes. The advent of new glucose-lowering drugs, such as semaglutide, can be very helpful in these patients and can significantly improve long-term cardiovascular outcomes.
Prof. Ning Tan
Some SGLT2 inhibitors and GLP-1 RA can provide effective cardiovascular protection, SGLT2 inhibitors have a good therapeutic effect on heart failure outcomes, and GLP-1 RA can comprehensively intervene in all links of the cardiovascular event chain (regulating risk factors and inhibiting atherosclerosis), and the protective effect on the cardiovascular system runs through the onset and development of CVD.
Prof. Lin Jinxiu (1st from left), Prof. Luo Yukun (2nd from left), Prof. Liu Qiang (3rd from left), Prof. Tan Ning (2nd from right), Prof. Li Lang (1st from right)
Summary
The prevalence and mortality of cardiometabolic diseases are on the rise, which seriously threatens the health of mainland residents, so they have received extensive attention in recent years. The new drug GLP-1 RA can comprehensively manage the risk factors of cardiometabolic diseases, inhibit the occurrence and progression of atherosclerosis, interrupt the chain of cardiovascular events at an early stage, and further improve the prognosis of patients, providing a very important "weapon" for cardiologists to manage cardiometabolic diseases.