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Welcome back to the CardioNerds Cardiovascular Prevention Series, where we are continuing our discussion of Glucagon-like Peptide-1 Receptor Agonists (GLP-1 RAs). This class of medications is becoming a household name, not only for their implications for weight loss but also for their effect on cardiovascular disease. CardioNerds Dr. Ty Sweeney (CardioNerds Academy Faculty Member and incoming Cardiology Fellow at Boston Medical Center), Dr. Rick Ferraro (CardioNerds Academy House Faculty and Cardiology Fellow at Johns Hopkins Hospital), and special guest Dr. Franck Azobou (Cardiology Fellow at UT Southwestern) sat down with Dr. Darren McGuire (Cardiologist at UT Southwestern and Senior Editor of Diabetes and Vascular Disease Research) to discuss important trial data on GLP-1 RAs in patients with heart disease, as well as recent professional society guidelines on their use. Show notes were drafted by Dr. Ty Sweeney. Audio editing was performed by CardioNerds Intern student Dr. Diane Masket. If you haven’t already, be sure to check out CardioNerds episode #350 where we discuss the basics and mechanism of action of GLP-1 RAs with Dr. Dennis Bruemmer. This episode was produced in collaboration with the American Society of Preventive Cardiology (ASPC) with independent medical education grant support from Novo Nordisk. See below for continuing medical education credit. Claim CME for this episode HERE. CardioNerds Prevention PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls and Quotes - GLP-1 Agonists: Diving into the Data Patients with diabetes and clinical atherosclerotic cardiovascular disease (ASCVD) or who are at high risk of ASCVD benefit from treatment with a GLP-1 RA. For persons with sufficient ASCVD risk and type 2 diabetes, GLP-1 RAs and SGLT2 inhibitors can, and often should, be used in combination. "Just like we don’t consider ‘and/or’ for the four pillars of guideline-directed medical therapy for heart failure with reduced ejection fraction, we shouldn’t parcel out these two therapeutic options...it should be both.” Setting expectations with your patients regarding injection practices, side effects, and expected benefits can go a long way toward improving the patient experience with GLP-1 RAs. Utilize a multidisciplinary approach when caring for patients on GLP-1 RAs. Build a team with your patient’s primary care provider, endocrinologist, clinical pharmacist, and nurse. “This is really a cardiologist issue. These are no longer endocrinology or primary care drugs. We need to be prescribing them ourselves just like we did back in the nineties when we took over the statin prescriptions from the endocrinology domain...we need to lead the way.” Show notes - GLP-1 Agonists: Diving into the Data For which patients are GLP-1 RAs recommended to reduce the risk of major cardiac events? For patients with type 2 diabetes and ASCVD, starting a GLP-1 RA carries a Class 1, Level of Evidence A recommendation in the most recent ESC and ACC guidelines. For patients without diabetes or clinical ASCVD with an estimated 10-year risk of CVD exceeding 10%, consideration of starting a GLP-1 RA carries a Class 2b, Level of Evidence C recommendation to reduce CV risk. The STEP-HFpEF trial showed that among patients with obesity and HFpEF, once-weekly semaglutide may be beneficial in terms of weight loss and quality of life. The results of the FIGHT and LIVE trials question the utility and safety of liraglutide in treating patients with advanced HFrEF. Of the over 17,000 patients enrolled in the SELECT trial, about 25% had heart failure, of which about one-third had HFrEF. Stay tuned for sub-analyses from that trial for more info! Can we still prescribe GLP-1 Ras in patients with well-controlled T2DM?

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NOTE FROM TED: Please do not look to this talk for medical advice. While some viewers might find advice provided in this talk to be helpful as a complementary approach, this speaker makes claims about nutrition and the human microbiome with too much certainty for the current state of research. TEDx events are independently organized by volunteers. The guidelines we give TEDx organizers are described in more detail here: http://storage.ted.com/tedx/manuals/tedx_content_guidelines.pdf Dr. Erika Ebbel Angle discusses why the gut microbiome is the most important organ you’ve probably never heard of. The gut is the second brain, and gut health affects your overall health. This means that you are what you eat, but you are also the metabolites that live in your gut and produce the substances you need for emotional balance, energy level, and disease prevention. Poor lifestyle choices cause gut imbalances, which can lead to neurodegenerative diseases, autoimmune diseases, and even anxiety and depression. Angle talks about three critical molecules and how they work in the body to affect your overall wellness. She also shares some tips about what you can do to maintain a healthy gut microbiome through diet and lifestyle choices. Entrepreneur and biochemist Erika Ebbel Angle, PhD, has dedicated her life to studying the gut. Dr. Angle is the CEO and co-founder of Ixcela, the Internal Fitness™ company. Ixcela evaluates the gut microbiome using a blood sample, and then offers personalized recommendations to restore gut health. Angle shares her lifelong love of science in many ways, including through her nonprofit, Science from Scientists, which brings scientists into classrooms to promote STEM careers and science education. A graduate of MIT and Boston University School of Medicine, Dr. Angle is also a former Miss Massachusetts who used her platform to encourage students to pursue STEM careers and scientific discovery. Erika Ebbel Angle, Ph.D., is the CEO and Co-founder of Ixcela, a biotechnology company aimed at developing tests and interventions to improve gut microbiome efficacy and health. She is also the Executive Director and Founder of Science from Scientists, an award-winning National nonprofit focused on improving Science, Technology, Engineering and Math (STEM) attitudes and aptitudes for children aged 9-13. Outside of work, Erika enjoys scuba diving, skiing, and classical piano. This talk was given at a TEDx event using the TED conference format but independently organized by a local community. Learn more at https://www.ted.com/tedx

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