Risultati per: Efficacia e sicurezza dei farmaci GLP-1 per il diabete di tipo 2 e l’obesità

Circulation, Volume 150, Issue Suppl_1, Page A4140660-A4140660, November 12, 2024. Background:Glucagon-like peptide-1 (GLP-1) receptor agonists are well-established glucose-lowering medications for the treatment of type 2 diabetes, and are cardio-protective by reducing the incidence of major adverse cardiovascular events (MACE). However, there is limited data available with conflicting results on safety of GLP-1RAs among patients with heart failure (HF) with chronic kidney disease (CKD) patients.Objective:To assess the potential therapeutic benefits of GLP-1RAs in HF patients with CKD.Method:We queried the TriNetX Global Collaborative Network for adult’s patients with heart failure and chronic kidney disease (CKD) from January 2005 to April 2023, and created two cohorts: one with heart failure and CKD on GLP-1 RAs and the other one heart failure and CKD on placebo as control cohort. Both the cohorts were followed for 12 months. We used the ICD-10-CM codes to identify comorbidities, and RxNorm for prescription. Demographics and laboratory values were reported by TriNetX. Propensity score matched analysis (PSM) was done for age, gender, race, hypertension, diabetes mellitus, chronic kidney disease, smoking status, hemoglobin level, LDL level, left ventricular ejection fraction and various drugs including ACEi, ARBi, beta blockers, aldosterone receptor antagonists, SGLT-2 inhibitors and statins. Primary outcome was all-cause mortality (ACM) while secondary outcomes were acute myocardial infarction (AMI), major adverse cardiovascular outcome (MACE) (Composite of ACM, AMI, and ischemic stroke), hemorrhagic stroke, and ischemic stroke.Resultsxs:Amongst the 1,05,414 patients (52, 707 patients in each group), the mean age of patients were 68.8 and 68.0 in GLP-1 RAs and control cohort respectively. PSM analysis showed that at one year of follow-up, GLP-1 RAs in heart failure with CKD patients was associated with significantly lower risk of primary outcome i.e., ACM (RR 0.400, 95% CI: 0.384-0.417) as compared with control. Heart failure with CKD patients on GLP-1 RAs were also associated with significantly reduced MACE (RR 0.536, 95% CI: 0.515-0.557), AMI (RR 0.633, 95% CI: 0.597-0.671), ischemic stroke (RR 0.760, 95% CI 0.712-0.811) and hemorrhagic stroke (RR 0.493, 95% CI 0.423-0.575) as compared with control.Conclusion:GLP-1 RAs use among patients with HF and CKD were associated with significant reduction in MACE, ACM, and stroke.

Circulation, Volume 150, Issue Suppl_1, Page A4141896-A4141896, November 12, 2024. Background:GLP-1 receptor agonists (GLP-1Ra) prevent atherosclerotic and chronic kidney disease (CKD) progression events in type 2 diabetes. In obesity without diabetes, GLP-1Ra lower the risk of atherosclerotic cardiovascular events. Less is known about the effects of GLP-1Ra on heart failure (HF) events and CKD progression events in people without type 2 diabetes and the benefits of adding GLP-1Ra to standard-of-care SGLT2 inhibitor therapy.Objective:Assess the association between genetic mimics of GLP1-Ra and SGLT2 inhibitor therapy on the risk of coronary artery disease (CAD), HF, and CKD.Methods:We used whole exome sequencing data from the All of Us Research Program to construct genetic instruments mimicking GLP1-Ra and SGLT2i therapy. The genetic instruments included variants in the GLP1R and SLC5A2 genes that associated with lower hemoglobin A1c levels in elastic net regression models with linkage disequilibrium pruning (r2< 0.3). Thus, higher genetic scores mimicked lifelong treatment with a GLP-1Ra or SGLT2 inhibitor. Having both higher GLP-1Ra and higher SGLT2i genetic scores mimicked lifelong exposure to combined therapy (Figure).Results:We included 245,388 All of Us participants (mean age 55 years, 59% females, 38% males, and 2% other genders). Higher GLP-1Ra genetic scores associated with a lower risk of CAD (OR [95% CI] per 1-standard deviation [SD]: 0.97 [0.95-0.99]; P=0.004), HF (OR [95% CI] per 1-SD: 0.95 [0.93-0.98]; P

Circulation, Volume 150, Issue Suppl_1, Page A4145342-A4145342, November 12, 2024. Background:Improved outcomes related to the use of glucagon-like peptide 1 (GLP-1) agonists in patients with cardiovascular disease (CVD) have been well documented. Small studies have shown benefits of GLP-1 agonists in reducing substance use in patients with substance use disorders (SUDs). In patients with CVD, co-occurring SUDs are known to worsen outcomes. The use of GLP-1 agonists to improve outcomes related to both CVD and SUD could improve healthcare disparities in this marginalized population.Hypothesis:The use of GLP-1 agonists in patients with CVD and SUD could improve outcomes related to both disease processes.Aim:Our aim is to describe clinical outcomes in patients with CVD and SUD who were prescribed GLP-1 agonists.Methods:This is a single-center retrospective cohort study of patients with CVD and SUD on a GLP-1 agonist. As previous studies have shown that change in body mass index (BMI) correlates with adherence to GLP-1 agonists, we stratified subjects by change in BMI over a two-year study period. Using SPSS, we analyzed number of hospital visits and conducted frequency analyses by type of CVD, type of SUD, and change in BMI during our study period.Results:The study population consists of 81 patients on GLP-1 agonists who have SUD and CVD. BMI decreased in 55 patients (67.9%), increased in 24 patients (29.6%), and remained the same in 2 patients (2.5%). Correlation analysis was conducted between change in BMI and the number of hospital visits related to SUD and CVD, indicating positive correlation between change in BMI and reduction in hospital visits related to both SUD (r=0.136, p= 0.230) and CVD (r=0.142, p= 0.208). Subgroup analyses were also performed by specific SUD type; patients with cocaine, cannabinoid, or alcohol use disorders had decreased hospital visits related to CVD (p

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Annals of Internal Medicine, Ahead of Print.

This cohort study aims to determine whether use of glucagon-like peptide 1 receptor agonists are associated with lower risk of developing cirrhosis and its complications, including decompensation and hepatocellular cancer, among patients with metabolic dysfunction-associated steatotic liver disease.