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

Autor: Alnima T; Radboud University Medical Center, Department of Internal Medicine, sections Vascular Medicine and Diabetology, Nijmegen., Smits MM; Amsterdam University Medical Center, Department of Internal Medicine., Hanssen NMJ; Amsterdam University Medical Center, Department of Internal Medicine.; Amsterdam Diabeter Center, Amsterdam UMC, Amsterdam, The Netherlands.
Jazyk: angličtina
Zdroj: Current opinion in lipidology [Curr Opin Lipidol] 2024 Dec 01; Vol. 35 (6), pp. 259-267. Date of Electronic Publication: 2024 Jul 29.
DOI: 10.1097/MOL.0000000000000949
Abstrakt: 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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Databáze: MEDLINE
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