The therapeutic approach to risk factors related to cardiovascular disease It is subject to a constant desire for research and innovation. Much of its adequate application to clinical practice depends on paying attention to the latest advances in this regard to, ultimately, reduce the mortality rates of cardiovascular pathology, which continues to be the leading cause of death in the world. In that sense, 2023 brought a series of pharmacological and therapeutic developments around addressing the diabetesthe obesity and the dyslipidemia.
“Last year was the year of obesity: the paradigm of its treatment has completely changed,” he highlighted. Alfredo Michan Doña, physician in the Internal Medicine service at the Jerez University Hospital, in Cádiz. His, along with Marta Casañas Martínezspecialist in Internal Medicine at the San Pedro Hospital, in Logroño, has been one of the two expert voices that, moderated by Miguel Ángel Sánchez Chaparroan internist at the Virgen de la Victoria University Hospital in Malaga, has reviewed the developments in this regard in 2023 at the XX Vascular Risk Meeting of the Spanish Society of Internal Medicine (SEMI) held in Malaga.
Michán has referred to the “avalanche” of new drugs to treat obesity, among them, retatrutidenew triple agonist which he has defined as “fundamental”. In the case of diabetes, he has highlighted the most recent developments from the American Diabetes Association (ADA), with special emphasis on aspects relevant to interologists such as the assessment of morbidities, peripheral arterial disease and heart failure.
To this he has added “less frequent aspects that tend to remain in the background” such as the assessment of bone health. He has also mentioned the need to promote “proactive detection” of diabetes by involving patients and, based on a selection of potentially affected people, performing ankle-brachial index tests and densitometryas well as assessing whether it is necessary to make a NT-proBNP and, if the result is positive, also a echocardiogram.
Regarding new drugs, Michán has highlighted two “that are going to change the future of diabetic patients”, namely, finerenone regarding kidney disease – including recommendations on how to manage potassium levels and avoid excess potassium morbidity and mortality-, and the tirzepatide regarding diabetes itself, although, regarding the latter, he has said that it is not yet known for sure if it will be used against obesity.
Aside from this, “the big change” around diabetes, according to the expert, is found in the fact that drugs initially designed for diabetic people are being applied to patients who do not suffer from this disease to alleviate kidney damage and reduce the morbidity and mortality of heart failure. The expert has also referred to a study in which he himself participated on the labile glycated hemoglobin in order to promote, “more than an early diagnosis, an early management to previously check the drug-induced changes so that, thus, there is no need to wait two or three months for this.”
But, above all, the therapeutic “key” for diabetes and obesity from now on in the future, according to Michán, will be the appearance of Selectthe study of morbidity and mortality events of the semaglutide from secondary prevention, that is, in people who have already suffered a vascular event, something that has already demonstrated its effect on reducing mortality. According to the internist, this will mean a “paradigm change” similar to the one that took place in 1992 with the sivastatin and the ischemic heart disease.
More effectiveness and equitable access to dyslipidemia therapies
Casañas, for his part, has made a summary of the most relevant publications of 2023 around the study of lipids, from articles about events to about combined therapydrugs and Peripheral arterial disease.
“We have to be more efficient in the treatment, try to improve its intensity using combined therapies and other tools that we have at our disposal to reach the objectives proposed in the guidelines sooner,” the internist indicated as a challenge. In this sense, she has appreciated that there are “promising drugs under study” and “interesting research” in development, especially focused on old people“which are always minors represented in studies.”
Regarding developments in the usual clinical practice of specialists in Internal Medicinehas highlighted the financing of three new drugs available to physicians in the field, although he has said that this financing is limited to people at greater risk of suffering a vascular event: those who have already suffered from it previously and those who have hypercholesterolemia. familiar.
Casañas, along the same lines, has lamented the differences in the use of these medications that exist among internists depending on the autonomous community in which they work, which only results in a “unbalanced access” of patients to these new therapies.
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