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Obesity Care Needs More Cardiology Support, Suggest 2 New Studies
ACC.2024: Two abstracts presented during the ACC Scientific Sessions indicate cardiologists are very hesitant to prescribe medical therapy for obesity.
Findings from 2 studies being presented at the American College of Cardiology Annual Scientific Sessions, April 608, 2024, in Atlanta, GA, highlight the potential for cardiologists to play a greater role in medical management of obesity, most importantly for their patients with or at risk for atherosclerotic cardiovascular disease (ASCVD).
The first study explored the use of contemporary antiobesity medications (AOMs) by specific drug and by clinical specialty.1 The second looked at the prioritization of weight management among individuals with obesity and ASCVD and their cardiology health care professionals.2
Researchers on both teams point to the growing body of evidence that supports the efficacy of new medications in reducing cardiometabolic risk and call for cardiology specialists to consider obesity care as integral to CV care.
As AOM prescriptions rise, where is cardiology?1
Prescriptions for antiobesity medications increased approximately 10-fold between 2018 and 2022 in a large US tertiary care system, written most frequently by clinicians in specialty weight management and primary care/internal medicine but by only a nominal proportion of cardiologists, according to this new study.
The research question asked by primary investigator John Ostrominski, MD, a clinical fellow in cardiovascular and obesity medicine at Brigham and Women’s Hospital and colleagues, was whether “contemporary real-world” prescribing of antiobesity pharmacotherapy varies by medication type or clinical specialty.
Using data from the multicenter Mass General Brigham health care system in Boston, MA, Ostrominski and fellow researchers retrospectively identified all first-time outpatient prescriptions written between January 1, 2018, and January 1, 2023, for AOMs approved for long-term use at the time of the study: liraglutide 3.0 mg, naltrexone-bupropion, orlistat, phentermine-topiramate, and semaglutide 2.4 mg.
The researchers found that over the full study period, there were 19 119 first-time prescriptions written for AOMs, with a nearly 10-fold increase from 1090 prescriptions in 2018 to 9832 prescriptions in 2022. At the time, liraglutide 3.0 mg was most frequently prescribed, followed by semaglutide 2.4 mg and naltrexone/bupropion. Liraglutide 3.0 mg and semaglutide 2.4 mg comprised the majority (89.9%) of all AOM prescriptions written between 2021 and 2022, according to the abstract.
Clinicians in specialty weight management (n = 7499; 39.2%) and primary care/internal medicine (n = 7450; 39.0%) prescribed the medications most frequently, with the 2 specialties accounting for more than three-quarters of the prescriptions initiated between 2018 and 2022. In contrast, AOMs initiated by cardiologists constituted only 0.76% of prescriptions during the same period.
Despite the significant increase in prescribing over the study period, study authors conclude that AOM prescriptions “remain substantially limited.” Moreover, “Given expanding outcomes data, further efforts are needed to engage cardiovascular medicine clinicians in antiobesity care,” they wrote.
Obesity is not my job2
Among a group of cardiologists and cardiology nurses and nurse practitioners obesity was ranked the fourth most important parameter to monitor both before and after an atherosclerotic cardiovascular disease (ASCVD)-related event, according to results of the new study. Moreover, the health care professionals taking part in the study had reported that 43% of their patients at high CV risk have a body mass index (BMI) of more than 30 mg/kg.2
Led by cardiologist Pam Taub, MD, professor of medicine at the UC San Diego School of Medicine in the division of cardiovascular medicine, the 2-part study was designed to augment knowledge of the established association between health outcome and obesity in individuals with ASCVD with insight into treatment perspectives from patients affected by both diseases and their treating cardiology specialists.
The first part of the study comprised a qualitative online study of patients (n = 61) and caregivers (n = 12) and interviews with those 2 groups and 24 cardiology health care professionals (HCP). The second part was a quantitative online survey of 120 cardiology HCPs, according to the abstract.
Half of the final cohort of patient respondents was aged 45-59 years and half was aged 60 years and older. The group was racially diverse with 38% identifying as Black/African American, 29% as White, 20% as Latinx, 10% as Asian, and 3% as mixed race, said Taub et al.
Two-thirds (66%) of the participants had been diagnosed with obesity, according to the abstract, and all had experienced at least 1 ASCVD event.
Patients. Taub and colleagues reported that 70% of participants believed that excessive weight was the “main risk factor” for an ASCVD event and yet for many, communication with HCPs about the relationship between obesity and CV health was described as poor. Some cited vague advice from HCPs on diet and exercise and reported that treatment plans were created without attention to cultural differences.
Among the group of HCP respondents, 83% were board certified cardiologists, 15% were cardiology nurses, and 2% were cardiology nurse practitioners.
Cardiology HCPs. Although nearly half of their patients with ASCVD had a BMI value that categorized them as having obesity, the disease was not ranked in the top 3 most important parameters requiring close monitoring or intervention either before or following an ASCVD event, according to the results. Further, Taub et al reported that more than half (53%) believe weight management is the main province of other specialties and most frequently refer patients back to a primary care clinician.
Echoing the findings by Ostrominski and colleagues that less than 1% of cardiologists initiated antiobesity pharmacotherapy, Taub and colleagues found that only 12% of cardiology HCP respondents recommend medical treatment for obesity. Nearly all (90%) of the respondents said they do recommend lifestyle changes, including diet and physical activity for their patients with obesity and ASCVD, however they admitted that because of time constraints, they rarely customize the recommendations for specific patient needs.
The authors conclude that even while acknowledging obesity as a risk factor for ASCVD, cardiology HCPs are not prioritizing medical management for the disease. They lament, too, that the hesitation to prescribe AOMs as part of a treatment regimen comes at a time when there are new and successful options.
