Razavi Alexander C, Cao Zhang Alexander M, Dardari Zeina A, Nasir Khurram, Khorsandi Michael, Mortensen Martin Bødtker, Al-Mallah Mouaz H, Shapiro Michael D, Daubert Melissa A, Blumenthal Roger S, Sperling Laurence S, Whelton Seamus P, Blaha Michael J, Dzaye Omar
Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, Georgia, USA.
Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
JACC Cardiovasc Imaging. 2025 Apr;18(4):451-461. doi: 10.1016/j.jcmg.2024.10.004. Epub 2025 Jan 8.
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.
Allocation of semaglutide was modeled according to coronary artery calcium (CAC) among individuals without diabetes or established atherosclerotic cardiovascular disease (CVD).
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.
Mean age was 61.2 years, 54% were female, 62% were non-White, mean body mass index was 31.8 kg/m, 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).
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.
由于药物供应和成本问题，司美格鲁肽减肥疗法的实施一直具有挑战性，这凸显了识别那些能获得最大绝对益处人群的必要性。
在无糖尿病或已确诊动脉粥样硬化性心血管疾病（CVD）的个体中，根据冠状动脉钙化（CAC）情况对司美格鲁肽的分配进行建模。
在本分析中，多民族动脉粥样硬化研究（MESA）中的3129名无糖尿病或临床CVD的参与者符合司美格鲁肽的体重体重指数指数标准，并接受了非增强心脏计算机断层扫描的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）、慢性肾脏病（CKD）和全因死亡率之间的关联。将SELECT（司美格鲁肽对超重或肥胖患者心脏病和中风的影响）试验（中位随访时间：3.3年）的风险降低估计值应用于司美格鲁肽5年治疗所需人数的观察发病率计算。
平均年龄为61.2岁，54%为女性，62%为非白人，平均体重指数为31.8kg/m，49%有CAC。与CAC = 0相比，CAC≥300使MACE风险增加2.2倍（HR：2.16 [95%CI：1.57 - 2.99]；P < 0.001）。在比较CAC≥300与CAC = 0时，还观察到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）和全因死亡率（HR：1.35 [95%CI：1.08 - 1.69]；P = 0.009）的风险更高。在MACE（653对79）、HF（1094对144）、CKD（1044对144）和全因死亡率（408对98）方面，CAC = 0与CAC≥300之间的5年治疗所需人数存在很大差异。
测量CAC可能会提高在无糖尿病或临床CVD的人群中使用减肥剂量司美格鲁肽的医疗价值，改善有限医疗资源的分配。
