使用冠状动脉CTA识别无糖尿病的高危肥胖个体以进行GLP-1RA治疗。
Identifying High-Risk Obese Individuals Without Diabetes for GLP-1RA Therapy Using Coronary CTA.
作者信息
Blair Camila V, Huck Daniel, Besser Stephanie A, Cardoso Rhanderson, Shiyovich Arthur, Berman Adam N, Biery David W, Weber Brittany N, Petranovic Milena, Nasir Khurram, Hedgire Sandeep, Plutzky Jorge, Cannon Christopher, Di Carli Marcelo F, Ghoshhajra Brian B, Trinquart Ludovic, Blankstein Ron
机构信息
Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Leon H. Charney Division of Cardiology, Department of Medicine, New York University Grossman School of Medicine, New York, New York, USA.
出版信息
JACC Adv. 2025 Jul 18;4(8):101995. doi: 10.1016/j.jacadv.2025.101995.
BACKGROUND
The SELECT trial demonstrated that semaglutide reduced major adverse cardiovascular events among individuals with cardiovascular disease (CVD) and overweight/obesity without diabetes. We hypothesized that coronary artery disease (CAD) detected by coronary computed tomography angiography (CCTA) identifies individuals with similar cardiovascular risk.
OBJECTIVES
The aim of the study was to evaluate the association between CAD severity by CCTA and cardiovascular outcomes among individuals resembling The SELECT (Semaglutide and Cardiovascular Outcomes in Obesity without Diabetes) trial population but without known CVD.
METHODS
We included individuals aged ≥45 years with body mass index ≥27 kg/m undergoing CCTA at 2 centers.
EXCLUSIONS
prior myocardial infarction, revascularization, stroke, diabetes, end-stage kidney disease, or malignancy. CAD severity was categorized as absent (0%), nonobstructive (1%-49%), or obstructive (≥50%). Extensive nonobstructive CAD was defined as plaque in all coronary arteries. Cox modeling assessed the association between CAD and the composite outcome of cardiovascular death, myocardial infarction, or stroke.
RESULTS
Among 5,173 individuals, 53% were male, and 68% and 62% had hypertension and dyslipidemia, respectively. Individuals with obstructive CAD had a 71% higher risk of events (adjusted HR: 1.71; 95% CI: 1.21-2.42; P = 0.002) vs those with no CAD. At 4 years, event risks were 7.8% for obstructive CAD and 7.7% for extensive nonobstructive CAD, comparable to SELECT's control arm (9.7%). Applying SELECT's relative rate reduction of 20%, the number needed to treat was 66 for obstructive and 67 for extensive nonobstructive CAD, comparable to SELECT's 56.
CONCLUSIONS
Obstructive or extensive nonobstructive CAD by CCTA identifies overweight/obese individuals without diabetes and no prior CVD as being at elevated cardiovascular risk, suggesting potential benefit from glucagon-like peptide-1 receptor agonist therapy.
背景
SELECT试验表明，司美格鲁肽可降低无糖尿病的心血管疾病（CVD）和超重/肥胖个体的主要不良心血管事件。我们假设，通过冠状动脉计算机断层扫描血管造影（CCTA）检测到的冠状动脉疾病（CAD）可识别出具有相似心血管风险的个体。
目的
本研究的目的是评估在类似于SELECT（无糖尿病肥胖患者的司美格鲁肽与心血管结局）试验人群但无已知CVD的个体中，CCTA显示的CAD严重程度与心血管结局之间的关联。
方法
我们纳入了2个中心年龄≥45岁、体重指数≥27kg/m²且接受CCTA检查的个体。
排除标准
既往心肌梗死、血运重建、中风、糖尿病、终末期肾病或恶性肿瘤。CAD严重程度分为无（0%）、非阻塞性（1%-49%）或阻塞性（≥50%）。广泛非阻塞性CAD定义为所有冠状动脉均有斑块。Cox模型评估CAD与心血管死亡、心肌梗死或中风复合结局之间的关联。
结果
在5173名个体中，53%为男性，分别有68%和62%患有高血压和血脂异常。与无CAD的个体相比，阻塞性CAD个体的事件风险高71%（调整后HR：1.71；95%CI：1.21-2.42；P=0.002）。4年时，阻塞性CAD的事件风险为7.8%，广泛非阻塞性CAD为7.7%，与SELECT试验的对照组（9.7%）相当。应用SELECT试验20%的相对风险降低率，阻塞性CAD的治疗所需人数为66，广泛非阻塞性CAD为67，与SELECT试验的56相当。
结论
CCTA显示的阻塞性或广泛非阻塞性CAD可识别出无糖尿病且无既往CVD的超重/肥胖个体具有较高的心血管风险，提示胰高血糖素样肽-1受体激动剂治疗可能有益。
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