The use of glucagon-like-peptide-1 receptor agonist in the cardiology practice

Abstract

The presence of type 2 diabetes confronts the patient with an elevated risk to develop atherosclerotic cardiovascular disease (ASCVD), heart failure (HF), or chronic kidney disease (CKD). Glucose control in itself does not prevent these complications in their entirety. More recently several agents within the class of Sodium-Glucose cotransporter 2 inhibitors (SGLT2-I) and Glucagon-like-peptide-1 receptor agonists (GLP-1RA) have emerged as preferred agents to tackle the residual risk of ASCVD, HF, and CKD in patients with type 2 diabetes. Despite compelling trial data and professional society endorsement, the uptake of these agents in clinical practice is low. Especially GLP-1RA is only used in 8% of eligible candidates with type 2 diabetes and <5% of these prescriptions are attributed to cardiologists. This low uptake amongst cardiologists is related to the unfamiliarity with this class, its initiation, and titration, hesitation regarding simultaneous adjustment of other glucose-lowering agents, the unaccustomedness to prescribing injectable agents, and differential medical priorities. This review aims to offer cardiologists a practical tool for the optimal use of a GLP-1RA in their suitable patients and is focussed on the Belgian field of practice.

Keywords:

• Diabetes
• atherosclerotic cardiovascular disease
• heart failure
• GLP1-receptor agonist
• quality of care
• weight loss

Disclosure statement

PM has received consultancy fees and unrestricted research grants from Abbott, AstraZeneca, Bayer, Boehringer-Ingelheim, Novartis, and Vifor Pharma. Pieter Martens has received research grants from Fonds Wetenschappelijk Onderzoek (grant number: 1127917N) and the European Society of Cardiology.

CM serves or has served on the advisory panel for Novo Nordisk, Sanofi, Merck Sharp, and Dohme Ltd., Eli Lilly and Company, Novartis, AstraZeneca, Boehringer Ingelheim, Roche, Medtronic, ActoBio Therapeutics, Pfizer, Insulet, and Zealand Pharma. Financial compensation for these activities has been received by KU Leuven; KU Leuven has received research support for CM from Medtronic, Novo Nordisk, Sanofi, and ActoBio Therapeutics; CM serves or has served on the speaker's bureau for Novo Nordisk, Sanofi, Eli Lilly and Company, Boehringer Ingelheim, Astra Zeneca, and Novartis. Financial compensation for these activities has been received by KU Leuven.

TV has served on the advisory board and/or speakers bureau for AstraZeneca, Boehringer Ingelheim, BMS/Pfizer, Novo Nordisk, and Sanofi.