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Obesity-Related Diseases - Obesity Algorithm 2024

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8 Disease Categories TOP 10 TAKEAWAY MESSAGES: Obesity and CVD 1. Obesity adversely affects heart and vascular anatomy and function. CVD and cancer are the most common causes of mortality among patients with obesity. 2. Obesity increases the risk of CVD both directly (e.g., via the adiposopathic effects of epicardial fat), and indirectly via the adiposopathic promotion of major CVD risk factors such as diabetes mellitus, high blood pressure, dyslipidemia, and thrombosis. 3. Patients with obesity benefit from global CVD risk reduction (e.g., healthful nutrition and physical activity, smoking cessation, as well as optimal control of blood sugar, blood pressure, and blood lipids). Additionally in the SELECT trial, semaglutide reduced MACE from 8% to 6.5% (19% relative risk reduction) over 3 years in individuals with obesity and established cardiovascular disease but without diabetes. This is similar to the relative risk reduction seen with statins. 4. Obesity may increase pericardial (paracardial and epicardial) fat, intracardial fat, visceral fat, and liver and skeletal muscle fat. Visceral and epicardial fat share the same mesodermal embryonic origin, both increase the risk for atherosclerosis, and both are highly correlated with coronary artery calcification. 5. Epicardial fat accumulation may directly contribute to heart failure with preserved ejection fraction (HFpEF), atherosclerotic CVD, dysrhythmias, fatty infiltration of the heart, and increased coronary calcium. HFpEF (diastolic heart failure) is especially common among patients with obesity, women, obstructive sleep apnea, older age, and CVD risk factors. 6. In patients with T2DM, GLP-1 RA have cardiovascular outcome trial (CVOT) evidence to support reduction in MACE (e.g., liraglutide, semaglutide, dulaglutide). Ongoing CVOTs include oral semaglutide 14 mg per day in patients with T2DM. Tirzepatide is a dual GLP-1 RA plus GIP receptor agonist being evaluated as an anti-obesity agent, as well as a treatment for T2DM and metabolic-associated steatohepatitis (MASH). In a CVOT, tirzepatide is being compared to dulaglutide on MACE in patients with type 2 diabetes mellitus (SURPASS-CVOT).

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