Thread by @HanchateShivani

1/ Starting off the morning with some of my favorite topics in Preventive Cardiology!

Here are my takeaways from Dr. Sheldon Litwin’s talk "Weight Management in Heart Failure" from Day 2 of #HeartofCardio #BackToHeart23 @CardioNerds ➡️➡️

2/ Is weight loss beneficial in cardiac disease? Yes

✨The LEGACY trial looked at goal directed weight management in pts w/ Afib and BMI > 27

- AFib is an obesity-related disease
- Pts that lost > 10% of body weight had a decreased AF burden

🔗 pubmed.ncbi.nlm.nih.gov/25792361/

3/ Another study at MUSC looked at pts w/ HFpEF and BMI > 43

▪️15 wks of intense lifestyle program including meal replacement, weekly meetings ➡️
- 7% body weight loss
- Sig increase in 6MWD

🔗 ahajournals.org/doi/10.1161/JA…

4/ Okay so lifestyle measures are effective but we cant stop here.

Although moderately effective, they are often not sustainable d/t

✴️ Metabolic adaptation —> weight recidivism

AKA pts gain the weight back despite maintaining appropriate caloric restriction 🫤

5/ What about weight loss medications? 🧐

💊Weight loss meds are:

▪️ More effective than lifestyle interventions
▪️ Widely applicable
▪️ Low risk
▪️ Sustainable effects over several years
▪️ High pt demand (one of the few meds pts request)

6/ Ex: GLP-1 Receptor Agonists

MOA: GLPs are incretins that stimulat insulin secretion AND inhibit glucagon

🔹Native GLP-1 is rapidly degraded by DPP-4

What happens when you add a fatty acid side chain?

🔹 GLP-1 RA that is resistant to degradation and has ⬆️ half life

7/ Show me the data!

Q Weekly Semaglutide led to 15% decrease in body weight, greater than any other weight loss drug to date!

🔸 study done in generally healthy 40 y/o women

🔗 nejm.org/doi/full/10.10…

8/ 🚨New kid on the block: Tirzepatide

SURMOUNT trial:

◽️Once weekly Tirzepatide lead to substantial and sustained reductions in body weight in pts w/ obesity.

🔗 nejm.org/doi/full/10.10…

9/ Alright medications work, but they only work when they are taken.

➡️pts regain weight back when they stop

⚠️The STEP-1 trial demonstrated that at 1 year after withdrawal of semaglutide, pts re-gained around 60% of their prior weight loss.

ncbi.nlm.nih.gov/pmc/articles/P…

10/ So how do we get sustainable, long term weight loss?

Gastric Bypass
🔺Slightly greater weight loss than meds
🔺More diabetic remission: 70% to 90% with GBS vs 35% w/ gastric sleeve
🔺 Improved CV outcomes
🔺Risks? few, GERD, 5% ulcer risk, 2% SBO, mineral malabsorption

11/ Newer techniques: Endoscopic Sleeve

AND - it leads to significant weight loss AND minimal GERD!

12/ So in SUMMARY

🔲 Lifestyle modification can ➡️moderate (7-8%) weight loss but difficult to sustain
🔲 Pharmacologic therapy can ➡️ 9-22% weight loss and reduce CV events
🔲Bariatric surgery is the most effective and sustainable way to achieve weight loss!

@LitwinSheldon @PatrickZakka @joyfuldockemi @MedscapeLIVE