Radboud University Medical Center, Department of Internal Medicine, sections Vascular Medicine and Diabetology, Nijmegen.
Amsterdam University Medical Center, Department of Internal Medicine.
Curr Opin Lipidol. 2024 Dec 1;35(6):259-267. doi: 10.1097/MOL.0000000000000949. Epub 2024 Jul 29.
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.
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.
GLP-1RAs improve lipid profiles in clinical trials, but their complete cardiovascular benefits likely involve multifactorial mechanisms beyond lipid modulation.
本文回顾了胰高血糖素样肽 1 受体激动剂 (GLP-1RAs) 对 2 型糖尿病和/或肥胖患者脂谱的影响，这对于优化心血管风险管理至关重要。
GLP-1RAs 通过减少肠载脂蛋白 B48 的产生和肠系膜淋巴流量，同时增加载脂蛋白 B100 的代谢来影响血脂水平。这些影响是直接的还是间接的尚不清楚，但血脂水平的改善与药物引起的体重减轻密切相关。临床试验表明，不同药物和剂量对脂谱有改善作用。我们认为，改善血脂水平不太可能足以解释 GLP-1RA 对心血管风险的有益影响，特别是考虑到在使用这些药物时，许多其他危险因素（体重、血糖控制、炎症）也得到了改善。大型心血管结局试验的事后中介分析可能会阐明每个危险因素的相对重要性。
GLP-1RAs 在临床试验中改善了脂谱，但它们对心血管的全面益处可能涉及多种因素，而不仅仅是脂代谢调节。
