Heart patients unsure about GLP-1 drugs? A physician’s advice is often the best medicine
The rise of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) is one of the biggest trends in modern medicine, changing the management of patients with type 2 diabetes, obesity and cardiovascular disease. While cardiologists are excited about these drugs, some patients are still apprehensive over potential side effects or the lack of long-term safety data. Founded or not, these concerns should be addressed to help patients better understand GLP-1 RAs.
A new article in the American Journal of Preventive Cardiology outlines how clinicians can counsel patients who have reservations about taking GLP-1s.[1]
"After decades of development and extensive clinical use, GLP-1 RAs have proven to be safe and effective therapies for cardiometabolic disease. The perception that they are 'too new' can be addressed through patient education, emphasizing that these agents amplify a physiologic hormone pathway, are supported by robust clinical and post-marketing evidence, and are generally well tolerated with manageable side effects," explained co-authors Priyansh Shah, MD, an internal medicine resident at Albert Einstein College of Medicine and president of the World Youth Heart Federation, and Romit Bhattacharya, MD, a preventive cardiologist at Massachusetts General Hospital and instructor at Harvard Medical School.
The two authors explained that patients will usually make an informed decision when they understand that GLP-1 RAs are the product of long-standing science. They said physicians need to point to the clear clinical evidence while also listening to their patients and establishing trust.
"Placing new drugs within their long developmental and clinical history reassures patients that serious long-term risks would likely have surfaced by now, while evidence instead demonstrates substantial cardiometabolic benefits alongside a well-defined safety profile," the authors explained.
The article includes a section of the documented side effects of GLP-1 RAs. The authors said clinicians need to be honest and explain the known side effects and the "theoretical risks" found in animal studies.
The most common side effects with GLP-1 RAs are gastrointestinal (GI) nausea, which is usually dose-dependent. This can occur during dose escalation and usually tapers off as the body adapts. Patients can also eat smaller meals or avoid rich/fatty foods initially to make the symptoms more manageable.
There were concerns about pancreatitis, pancreatic cancer and thyroid cancer in early studies of these drugs, but these issues were never shown in the larger clinical trials. Thyroid cancer is often brought up by patients because of an FDA-mandated warning about medullary thyroid carcinoma in rodents, but there have bo no signs of that trend in human trials.
Click here to read the full study.
Dave Fornell has covered healthcare for more than 17 years, with a focus in cardiology and radiology. Fornell is a 5-time winner of a Jesse H. Neal Award, the most prestigious editorial honors in the field of specialized journalism. The wins included best technical content, best use of social media and best COVID-19 coverage. Fornell was also a three-time Neal finalist for best range of work by a single author. He produces more than 100 editorial videos each year, most of them interviews with key opinion leaders in medicine. He also writes technical articles, covers key trends, conducts video hospital site visits, and is very involved with social media. E-mail: [email protected]