It’s been a working weekend for me, as I have been lucky enough to attend the European Society of Cardiology meeting in London. It’s possibly the largest cardiology meeting in the world, rotating through a number of major European cities each year. There are 10s of thousands of delegates, hundreds of stands and presentation. It is HUGE! There has been so much content, that this week I’ll use both this email and my video to bring you the stand out messages.
Interestingly enough, one of the trials actually made it onto Sky news this morning. The article I saw online concerned the drug semaglutide, which is the weight-loss ‘wonder-drug’ that seems to have taken the world by storm. There has been considerable mention of this class of drugs (called GLP-1 agonists) at the conference, and I have conflicting emotions on them. Let me start with my emotions! I find the statistics pretty depressing – there has been around a 400% increase in obesity over the last 30 years, and childhood obesity in particular is at unprecedented levels. Conceptually therefore the idea that so many people need to turn to a medication to manage this epidemic is sad. However there is no doubt that the data clearly show that these drugs reduce weight more effectively than lifestyle interventions, with weight loss of 10-20% of bodyweight easily achievable. It also significantly reduces waist circumference. However, people put the weight back on if they stop the drug, and although it doesn’t seem to get much airtime at the conference, it’s therefore CRITICAL that whilst patients are on the drug, they adopt those healthy behaviours that will enable them to keep the weight off once the drug stops. Are we really ok with a third of the adult population taking this stuff for the rest of their lives? From a population health perspective, preventing obesity in the first place has to be prioritised. It’s also worth noting that even on the drug, the majority of patients are still in the obese category (but that is better than severely obese of course).
The data is also clear that there is a lower risk of adverse cardiovascular outcomes though (and this appears to be beyond simply the weight loss, and no-one really has a good explanation as to why). This was the focus of many sessions over the last couple of days. Whether diabetic or not, these drugs can have an enormous impact. There is however the issue of supply – worldwide shortages mean it is actually pretty hard to get the drug prescribed.
The benefit is even more clear in patients with heart failure. In the form of heart failure where the heart squeezes well but is slow to relax (known as preserved ejection fraction) the symptom improvement with semaglutide was the largest seen in any trial!
Another trial which really caught my eye looked at stopping beta blocker drugs >6 months after a heart attack. Conventional teaching is that these drugs should be used lifelong. I must précis this by saying no-one should discontinue any medication without personalised advice from their specialist. There was no increase in heart attacks or strokes in the patients who stopped the beta blockers, although there was a slight rise in blood pressure and heart rate. This may mean a change of dose in other medication. There was a slight rise in hospitalisations. This trial will change my practice, in that I will now have that discussion with my patients and it may well be a number of them decide to stop beta blockers in the long term.
Lastly, the new guidelines for patients with chronic coronary disease – ie furring up of the heart arteries, recommend long-term treatment with the anti-inflammatory drug colchicine. We commonly use this drug for inflammation of the sack the heart sits in (pericarditis). It’s (yet another!) tablet, but again, one to discuss with my patients to see if they would like to try it.