Glucagon-like peptide-1 (GLP-1) is a gut hormone released in response to food intake. Initial studies of GLP-1 focused on its role in stimulating insulin secretion, suppressing glucagon secretion, and slowing gastric emptying, which has marked effects on postprandial glycemic excursions. Given the effects of GLP-1 on plasma glucose, GLP-1 receptor agonists (RAs) initially emerged as treatments for type 2 diabetes.

Because GLP-1 reduces appetite and increases satiety, certain GLP-1 RAs are used for weight loss/management in patients who are obese or overweight and have at least 1 weight-related comorbidity. Interestingly, GLP-1 RAs promote weight loss while reducing the glycemia level, which in turn limits glucosuria and should therefore have been associated with weight gain. The appetite-suppressing effects of GLP-1 RAs are hypothesized to involve interaction with key neural circuits in specific brain regions and circuits involved in the homeostatic or hedonic regulation of energy household and food intake.

While GLP-1 RAs modify cardiovascular (CV) risk via glucose control and weight loss, they may have other cardioprotective effects. There is increasing evidence that GLP-1 RAs reduce CV inflammation. GLP-1 RAs may also modify CV risk by increasing natriuresis and diuresis, lowering blood pressure and postprandial lipids, and inhibiting coagulation.

The GLP-1 RA semaglutide recently became the first weight-loss medication approved to reduce the risk of major adverse cardiovascular events (MACE) in adults with established CV disease and overweight or obesity. This approval was based on the results of the randomized, placebo-controlled SELECT trial (NCT03574597).

What percentage of your patients are overweight or obese with established CV disease? Would you recommend a GLP-1 RA for these patients?