Allocation of Semaglutide According to Coronary Artery Calcium and BMI: Applying the SELECT Trial to MESA.

IF 12.8 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS JACC. Cardiovascular imaging Pub Date : 2025-01-03 DOI:10.1016/j.jcmg.2024.10.004

Alexander C Razavi, Alexander M Cao Zhang, Zeina A Dardari, Khurram Nasir, Michael Khorsandi, Martin Bødtker Mortensen, Mouaz H Al-Mallah, Michael D Shapiro, Melissa A Daubert, Roger S Blumenthal, Laurence S Sperling, Seamus P Whelton, Michael J Blaha, Omar Dzaye

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Abstract

Background: Implementation of semaglutide weight loss therapy has been challenging due to drug supply and cost, underscoring a need to identify those who derive the greatest absolute benefit.

Objectives: Allocation of semaglutide was modeled according to coronary artery calcium (CAC) among individuals without diabetes or established atherosclerotic cardiovascular disease (CVD).

Methods: In this analysis, 3,129 participants in the MESA (Multi-Ethnic Study of Atherosclerosis) without diabetes or clinical CVD met body mass index criteria for semaglutide and underwent CAC scoring on noncontrast cardiac computed tomography. Cox proportional hazards regression assessed the association of CAC with major adverse cardiovascular events (MACE), heart failure (HF), chronic kidney disease (CKD), and all-cause mortality. Risk reduction estimates from the SELECT (Semaglutide Effects on Heart Disease and Stroke in Patients with Overweight or Obesity) trial (median follow-up: 3.3 years) were applied to observed incidence rates for semaglutide 5-year number-needed-to-treat calculations.

Results: Mean age was 61.2 years, 54% were female, 62% were non-White, mean body mass index was 31.8 kg/m², and 49% had CAC. Compared with CAC = 0, CAC ≥300 conferred a 2.2-fold higher risk for MACE (HR: 2.16 [95% CI: 1.57-2.99]; P < 0.001). Higher risks for HF (HR: 2.80 [95% CI: 1.81-4.35]; P < 0.001), CKD (HR: 1.59 [95% CI: 1.15-2.22]; P = 0.006), and all-cause mortality (HR: 1.35 [95% CI: 1.08-1.69]; P = 0.009) comparing CAC ≥300 vs CAC = 0 were also observed. There were large 5-year number-needed-to-treat differences between CAC = 0 and CAC ≥300 for MACE (653 vs 79), HF (1,094 vs 144), CKD (1,044 vs 144), and all-cause mortality (408 vs 98).

Conclusions: Measurement of CAC may enhance value of care with weight loss dose semaglutide in those without diabetes or clinical CVD, improving allocation of a limited health care resource.

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根据冠状动脉钙和BMI分配西马鲁肽：将SELECT试验应用于MESA。

背景：由于药物供应和成本的原因，实施西马鲁肽减肥疗法一直具有挑战性，强调需要确定那些获得最大绝对益处的人。目的：在没有糖尿病或已建立的动脉粥样硬化性心血管疾病（CVD）的个体中，根据冠状动脉钙（CAC）来模拟西马鲁肽的分配。方法：在这项分析中，3129名无糖尿病或临床心血管疾病的MESA（多种族动脉粥样硬化研究）参与者符合西马鲁肽体重指数标准，并在非对比心脏计算机断层扫描上进行CAC评分。Cox比例风险回归评估了CAC与主要不良心血管事件（MACE）、心力衰竭（HF）、慢性肾脏疾病（CKD）和全因死亡率的关系。来自SELECT （Semaglutide对超重或肥胖患者心脏病和卒中的影响）试验（中位随访：3.3年）的风险降低估计值应用于观察到的Semaglutide 5年需要治疗数的发生率计算。结果：平均年龄61.2岁，女性占54%，非白种人占62%，平均体重指数31.8 kg/m2， CAC患者占49%。与CAC = 0相比，CAC≥300的MACE风险增加2.2倍(HR: 2.16 [95% CI: 1.57-2.99]；P < 0.001)。HF风险较高(HR: 2.80 [95% CI: 1.81-4.35]；P < 0.001), CKD (hr: 1.59 [95% ci: 1.15-2.22]；P = 0.006)，全因死亡率(HR: 1.35 [95% CI: 1.08-1.69]；P = 0.009)，比较CAC≥300和CAC = 0。在MACE （653 vs 79）、HF （1094 vs 144）、CKD （1044 vs 144）和全因死亡率（408 vs 98）中，CAC = 0和CAC≥300的5年需要治疗数量存在很大差异。结论：检测CAC可提高西马鲁肽减重剂量对无糖尿病或临床心血管疾病患者的护理价值，改善有限医疗资源的分配。

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

JACC. Cardiovascular imaging CARDIAC & CARDIOVASCULAR SYSTEMS-RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

CiteScore

24.90

自引率

5.70%

发文量

330

审稿时长

4-8 weeks

期刊介绍： JACC: Cardiovascular Imaging, part of the prestigious Journal of the American College of Cardiology (JACC) family, offers readers a comprehensive perspective on all aspects of cardiovascular imaging. This specialist journal covers original clinical research on both non-invasive and invasive imaging techniques, including echocardiography, CT, CMR, nuclear, optical imaging, and cine-angiography. JACC. Cardiovascular imaging highlights advances in basic science and molecular imaging that are expected to significantly impact clinical practice in the next decade. This influence encompasses improvements in diagnostic performance, enhanced understanding of the pathogenetic basis of diseases, and advancements in therapy. In addition to cutting-edge research,the content of JACC: Cardiovascular Imaging emphasizes practical aspects for the practicing cardiologist, including advocacy and practice management.The journal also features state-of-the-art reviews, ensuring a well-rounded and insightful resource for professionals in the field of cardiovascular imaging.

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