Are the lipid-lowering effects of incretin-based therapies relevant for cardiovascular benefit?

IF 3.8 3区医学 Q2 BIOCHEMISTRY & MOLECULAR BIOLOGY Current opinion in lipidology Pub Date : 2024-12-01 Epub Date: 2024-07-29 DOI:10.1097/MOL.0000000000000949

Teba Alnima, Mark M Smits, Nordin M J Hanssen

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Abstract

Purpose of review: This review examines the impact of glucagon-like peptide 1 receptor agonists (GLP-1RAs) on lipid profiles in individuals with type 2 diabetes mellitus and/or obesity, crucial for optimizing cardiovascular risk management.

Recent findings: GLP-1RAs affect lipid levels by reducing intestinal apolipoprotein B48 production and mesenteric lymph flow, while increasing catabolism of apolipoprotein B100. It remains unknown whether these effects are direct or indirect, but the improvements in lipid levels are strongly correlated to the drug-induced weight loss. Clinical trials demonstrate improvements in lipid profiles, with different effects per agent and dose. We deem it unlikely that improved lipid levels are sufficient to explain the beneficial effects of GLP-1RA on cardiovascular risk, especially given the improvement of many other risk factors (body weight, glycemic control, inflammation) while using these agents. Posthoc mediation analyses of large cardiovascular outcome trials may shed some light on the relative importance of each risk factor.

Summary: GLP-1RAs improve lipid profiles in clinical trials, but their complete cardiovascular benefits likely involve multifactorial mechanisms beyond lipid modulation.

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基于增量素的疗法的降脂效果与心血管益处相关吗？

综述目的：本综述探讨了胰高血糖素样肽 1 受体激动剂（GLP-1RAs）对 2 型糖尿病和/或肥胖患者血脂状况的影响，这对优化心血管风险管理至关重要：最新发现：GLP-1RA 通过减少肠道载脂蛋白 B48 的产生和肠系膜淋巴流量，同时增加载脂蛋白 B100 的分解，从而影响血脂水平。目前尚不清楚这些影响是直接的还是间接的，但血脂水平的改善与药物引起的体重减轻密切相关。临床试验显示血脂状况有所改善，但每种药物和剂量的效果不同。我们认为，血脂水平的改善不足以解释 GLP-1RA 对心血管风险的有利影响，尤其是考虑到在使用这些药物的同时，许多其他风险因素（体重、血糖控制、炎症）也得到了改善。总结：在临床试验中，GLP-1RA 可改善血脂状况，但其对心血管的全面益处可能涉及血脂调节以外的多因素机制。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Current opinion in lipidology 医学-内分泌学与代谢

CiteScore

6.70

自引率

4.50%

发文量

审稿时长

6-12 weeks

期刊介绍： With its easy-to-digest reviews on important advances in world literature, Current Opinion in Lipidology offers expert evaluation on a wide range of topics from six key disciplines including nutrition and metabolism, genetics and molecular biology, and hyperlipidaemia and cardiovascular disease. Published bimonthly, each issue covers in detail the most pertinent advances in these fields from the previous year. This is supplemented by a section of Bimonthly Updates, which deliver an insight into new developments at the cutting edge of the disciplines covered in the journal.