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CardioNerds (Drs. Gurleen Kaur and Richard Ferraro) and episode FIT Lead Dr. Spencer Carter (Cardiology Fellow at UT Southwestern) discuss the clinical implementation of GLP-1 receptor agonists with Dr. Neha Pagidapati (Faculty at Duke University School of Medicine). In this episode of the CardioNerds Cardiovascular Prevention Series, we discuss the clinical implementation of glucagon-like peptide-1 (GLP-1) receptor agonists. We cover the clinical indications, metabolic and cardiovascular benefits, and potential limitations of these emerging and exciting therapies. Show notes were drafted by Dr. Spencer Carter. Audio editing was performed by CardioNerds Academy Intern, student Dr. Pacey Wetstein. 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. CardioNerds Prevention PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls and Quotes - Clinical Implementation of GLP-1 Receptor Agonists GLP-1 agonists work through a variety of mechanisms to counteract metabolic disease. They increase insulin secretion, inhibit glucagon secretion, slow gastric motility, and increase satiety to limit excess energy intake. Patients with type II diabetes and an elevated risk for atherosclerotic cardiovascular disease should be considered for GLP-1 agonist therapy regardless of hemoglobin A1c. GLP-1 agonists offer significant ASCVD risk reduction even in the absence of diabetes. Newer data suggest a significant reduction in cardiovascular events with GLP-1 agonist therapy in patients who are overweight or obese and have a prior history of heart disease. GLP-1 agonists should generally be avoided in patients with a history of medullary thyroid cancer or MEN2. As these medications slow gastric emptying, relative contraindications include history of recurrent pancreatitis and gastroparesis. GLP-1 agonists should be initially prescribed at the lowest dose and slowly uptitrated to avoid gastrointestinal side effects. Show notes - Clinical Implementation of GLP-1 Receptor Agonists What were the groundbreaking findings of the STEP1 and SURMOUNT-1 trials and how these impact cardiovascular wellness? The STEP1 and SURMOUNT trials demonstrated sustained clinically relevant reduction in body weight with semaglutide and tripeptide, respectively, in patients with overweight and obesity. As obesity is an important risk factor for the development of cardiovascular disease, weight reduction meaningfully contributes to cardiovascular wellness. What were the findings of the LEADER trial and their implications for patients with type II diabetes and high cardiovascular risk? The LEADER trial demonstrated a significant reduction in the rate of cardiovascular death, nonfatal MI, or nonfatal stroke in patients with type II diabetes treated with liraglutide. GLP-1 receptor agonist therapy should be considered in all patients with type II diabetes and elevated ASCVD risk regardless of A1c or current hyperglycemic therapy. What are current indications for GLP1 agonists in the context of cardiometabolic disease. GLP-1 receptor agonists should be considered in patients with type II diabetes and high ASCVD risk OR patients without diabetes who are overweight/obese and have a history of cardiovascular disease. What are important side effects or contraindications to GLP1 agents when used for cardiovascular risk reduction and wellness? GLP-1 receptor agonists should be avoided in patients with a history of medullary thyroid cancer or MEN2. Relative contraindications include recurrent pancreatitis, gastroparesis,

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How Do Ozempic and Wegovy Work? Ozempic and Wegovy are synthetic GLP-1 molecules named Semaglutide. Ozempic is approved for type II diabetes mellitus and protection against cardiac events in type II DM patients. Wegovy is approved for weight loss in obese and overweight individuals and for protection against cardiac events in obese and overweight individuals. Let's review the mechanism of action and the side effects of these drugs. If you like this content and want more, click here: https://www.drbeen.com/med-nerd Want to join my uncensored talks? Join me on patreon or substack: Patreon: https://www.patreon.com/mobeensyed?fan_landing=true Substack: https://mobeensyedmd.substack.com/ Want to support this work?: BuyMeACoffee: https://www.buymeacoffee.com/drmobeensyed PayPal: https://paypal.me/mobeensyed?locale.x=en_US #drbeen #koolbeens #Weight_Loss Disclaimer: This video is not intended to provide assessment, diagnosis, treatment, or medical advice; it also does not constitute provision of healthcare services. The content provided in this video is for informational and educational purposes only. Please consult with a physician or healthcare professional regarding any medical or mental health related diagnosis or treatment. No information in this video should ever be considered as a substitute for advice from a healthcare professional. FDA Approves First Treatment to Reduce Risk of Serious Heart Problems Specifically in Adults with Obesity or Overweight | FDA https://www.fda.gov/news-events/press-announcements/fda-approves-first-treatment-reduce-risk-serious-heart-problems-specifically-adults-obesity-or Ozempic for weight loss: Does it work, and what do experts recommend? https://health.ucdavis.edu/blog/cultivating-health/ozempic-for-weight-loss-does-it-work-and-what-do-experts-recommend/2023/07 Semaglutide delays 4-hour gastric emptying in women with polycystic ovary syndrome and obesity - PubMed https://pubmed.ncbi.nlm.nih.gov/36511825/ The metabolic role of vagal afferent innervation | Nature Reviews Gastroenterology & Hepatology https://www.nature.com/articles/s41575-018-0062-1 Glucagon-like peptide-1 inhibits gastropancreatic function by inhibiting central parasympathetic outflow | American Journal of Physiology-Gastrointestinal and Liver Physiology https://journals.physiology.org/doi/full/10.1152/ajpgi.1998.275.5.G984 Wegovy® Pen Instructions | Wegovy® (semaglutide) Injection 2.4 mg https://www.wegovy.com/taking-wegovy/how-to-use-the-wegovy-pen.html Incretin https://en.wikipedia.org/wiki/Incretin Glucagon-like peptide-1 inhibits gastric emptying via vagal afferent-mediated central mechanisms - PubMed https://pubmed.ncbi.nlm.nih.gov/9357836/ Give the Receptor a Brake: Slowing Gastric Emptying by GLP-1 | Diabetes | American Diabetes Association https://diabetesjournals.org/diabetes/article/63/2/407/34120/Give-the-Receptor-a-Brake-Slowing-Gastric-Emptying GLP-1 Localisation and Proglucagon Gene Expression in Healthy and Diabetic Mouse Ileum - PMC https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6200298/#:~:text=For%20instance%2C%20proglucagon%20is%20cleaved,13%2C%2016%2C%2027). What Is an L-Cell and How Do We Study the Secretory Mechanisms of the L-Cell? - PMC https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8218725/ Glucagon-Like Peptide-1 Receptor Agonists for Chronic Weight Management - PMC https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10533252/ Glucagon-like peptide-1 inhibits gastropancreatic function by inhibiting central parasympathetic outflow | American Journal of Physiology-Gastrointestinal and Liver Physiology https://journals.physiology.org/doi/full/10.1152/ajpgi.1998.275.5.G984 Why Ozempic Causes Diarrhea and How to Manage Your Symptoms - GoodRx https://www.goodrx.com/ozempic/diarrhea Wegovy (Semaglutide): Uses, Side Effects & Weight Loss https://www.drugwatch.com/drugs/wegovy/#:~:text=Wegovy%20carries%20a%20black%20box,same%20effects%20occur%20in%20humans. Risk of Gastrointestinal Adverse Events Associated With Glucagon-Like Peptide-1 Receptor Agonists for Weight Loss | Gastroenterology | JAMA | JAMA Network https://jamanetwork.com/journals/jama/fullarticle/2810542 The metabolic role of vagal afferent innervation | Nature Reviews Gastroenterology & Hepatology https://www.nature.com/articles/s41575-018-0062-1 What Is an L-Cell and How Do We Study the Secretory Mechanisms of the L-Cell? - PMC https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8218725/ Enteroendocrine cell - Wikipedia https://en.wikipedia.org/wiki/Enteroendocrine_cell#:~:text=in%20the%20duodenum.-,L%20cell,in%20the%20duodenum%20and%20jejunum. What is ilial brake? inslag.indd https://scholarlypublications.universiteitleiden.nl/access/item%3A2956466/view Hypothalamic circuits regulating appetite and energy homeostasis: pathways to obesity - PMC https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5483000/#:~:text=Distinct%20neuronal%20cell%20populations%2C%20particularly,glucose%20metabolism%20and%20energy%20expenditure.

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