AOMs Reduce CVD Risk in Obese Medicare Patients

Obesity is a leading cause of disease and mortality, primarily from cardiovascular disease (CVD), which accounts for around 18 million deaths annually. Novel anti-obesity drugs (AOMs) are currently being used in clinical and experimental settings to address this escalating public health concern.

The effect of these novel medications on CVD in obese people is examined in a recent study that was published in the journal Obesity.

AOMs: What Are They?

While AOMs have been licensed for the treatment of obesity, the current study assessed their effects on several cardiovascular diseases using real-world data.

Based on clinical trials, AOMs such as tirzepatide and semaglutide may be able to reduce the incidence of CVD in those who are overweight or obese. Glucagon-like peptide 1 (GLP-1) inhibitors such as tirzepatide and semaglutide were first licensed to regulate blood sugar levels, but they have now been demonstrated to be efficient weight reduction agents.

Wegovy is an anti-obesity medication that was approved in 2021 for the long-term control of body weight, notwithstanding semaglutide’s 2017 approval due to its capacity to cause weight loss of up to 15% of body weight.

After receiving approval in 2022, tirzepatide’s effect on weight loss was further studied. Tirzepatide was approved for this indication in 2023 as a result of its ability to cause weight loss of up to 20%.

Medicare beneficiaries who were 65 years of age or older and obese were included in the current study. At least half of the patients in this group have heart problems, and as a result, their medical expenses are doubled compared to those who do not have cardiac disease. This has caused the viability and efficacy of covering AOMs under Medicare to be re-examined.

Concerning the study

In this retrospective analysis, cardiovascular outcomes for Medicare patients with obesity who received newly approved AOMs between 2020 and 2022 are compared. There were around 6,000 patients getting tirzepatide or semaglutide in the study, while there were 79,000 controls.

The AOM group had an average age that was somewhat lower, but it also had a higher comorbidity score of two or higher and a higher likelihood of having a poor socioeconomic level (SES). In addition, the AOM cohort had higher rates of type 2 diabetes and hyperlipidemia—roughly 65% and 40%, respectively, as opposed to 25% and 30%, respectively—as well as hypertension (72%), compared to 61% among controls.

The majority of patients were prescribed Ozempic (semaglutide), but Wegovy (tirzepatide) was prescribed to 375 patients, and Mounjaro (tirzepatide) to 147 patients. High blood lipid levels, type 2 diabetes, and hypertension were the most prevalent conditions among these patients.

What findings did the study make?

Heart failure and other cardiovascular problems were 8% less likely to occur in patients receiving AOM treatment. Patients between the ages of 71 and 80 showed the greatest benefit, with a 33% lower risk than those between the ages of 65 and 70. In contrast, patients who were at least 80 years old had a twice as high risk as those who were 65 to 70 years old.

While residents of low- and medium-SES areas were more at risk than those from high-SES areas, females had a 26% lower risk of CVD than males.

Using AOMs prevented CVD for the first year after use, but not for longer. Over the 1,000 days, the risk was lower for younger females; however, the risk of CVD was steadily increasing for those with higher comorbidity scores.

For the first three months and between 720 and 960 days, hyperlipidemia was linked to a lower risk of CVD; after that, the risk rose. This could be an artifact since patient outcomes may have improved as a result of treatment for hyperlipidemia. For the first 660 days, smoking was linked to a higher risk of CVD and chronic renal disease.  

Heart failure incidence was 4.9% against 6.1% in patients who were not receiving treatment. Similarly, 3.8% of AOM recipients experienced atrial fibrillation, compared to 5.1% of patients who did not get treatment.

Between the two groups, the incidence of peripheral vascular disease decreased from 3.44% to 2.9%, while the proportion of patients experiencing arrhythmias was 3.6% for treated patients and 4.1% for untreated patients. In total, there was an 8% decrease in the risk of any CVD events.

In conclusion

By lowering the prevalence of this modifiable risk factor, the use of AOMs in obese patients lowers their risk of CVD. It has been demonstrated in earlier research that reducing 5–10% of body weight can effectively improve blood pressure, blood lipid levels, and blood glucose control in a dose-dependent manner.

Further research is required to clarify the mechanism underlying weight loss linked to AOMs, the impact on CVD, and the effects of reducing the cost of access to AOMs for this population.

For more information: The association between weight loss medications and cardiovascular complications, Obesity,  https://doi.org/10.1002/oby.24037