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GLP-1s Are Reshaping Cardiovascular Care: Cedars-Sinai

Cedars-Sinai experts are advocating for patients to have access to GLP-1 medications such as semaglutide as a key component to caring for and preventing cardiovascular disease. 

Physicians are now able to improve multiple "downstream" conditions, such as heart disease, by prescribing one medication "upstream," according to a Jan. 10 news release from Los Angeles-based Cedars Sinai. 

Amanda Velazquez, MD, director of obesity medicine at the health system, said in the release that semaglutide has enabled patients with high blood pressure to reduce their antihypertensive medications.

Martha Gulati, MD, director of preventive cardiology and the Anita Dann Friedman Chair in Women's Cardiovascular Medicine and Research at Cedars-Sinai, said although semaglutide has been associated with blood pressure and cholesterol level improvements, it does not replace statins. 

Dr. Gulati also said the effectiveness of the drug class raises the important question: "Do we want patients to get CVD and only then treat them? Or should we treat them earlier so we can prevent CVD events?"

Access and availability of GLP-1 medications are not keeping up with the number of patients who could see benefits from the drugs. Insurance coverage eligibility, "leaves out a huge population of patients who are trying to be proactive about CVD prevention," Valentina Obreja, DNP, a prevention clinic nurse practitioner at the Barbra Streisand Women's Heart Center in the Cedars-Sinai Smidt Heart Institute, said in the release. 

The health system has taken an integrative approach to addressing cardiovascular health across specialties, combining medication, lifestyle modifications and surgery to maximize the cardiovascular benefit, the release said. 

"The more we pool our efforts and resources as healthcare providers, the better off these patients become," Dr. Gulati said. 

Read the full news release here. 


Certain Drug Types Associated With Risk For Dementia

HealthDay News — Antimicrobials, vaccines, and anti-inflammatories are associated with a reduced risk for Alzheimer disease and dementia, while antipsychotics and drugs for diabetes are associated with an increased risk, according to a review published online January 21 in Alzheimer's & Dementia: Translational Research & Clinical Interventions.

Benjamin R. Underwood, PhD, from the University of Cambridge in the United Kingdom, and colleagues conducted a systematic review to examine the association between a range of prescribed medications and dementia risk. Fourteen studies with administrative or medical records data from more than 130 million individuals and 1 million dementia cases were included.

The researchers found that some themes emerged for drug classes with biological plausibility, despite inconsistencies in identifying specific drugs that may modify Alzheimer disease or dementia risk. Reduced risk was seen in association with antimicrobials, vaccinations, and anti-inflammatories, while an increased risk was seen in association with diabetes drugs, vitamins and supplements, and antipsychotics. Evidence for antihypertensives and antidepressants was found to be conflicting.

"Though the results are not immediately clear-cut for individual drugs, some expected and some unexpected patterns have emerged," the authors write. "Understanding whether drugs in current use could be repurposed for use in dementia is an urgent priority and will become more important with the emergence of platform trials in the field."

One author disclosed ties to Lilly and TauRx.

Abstract/Full Text


AKI May Increase Risk For Dementia, Cognitive Impairment For Older Adults

January 21, 2025

1 min read

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  • The rate of probable dementia was higher for adults with vs. Without AKI.
  • The composite of mild cognitive impairment and probable dementia was also higher among patients with AKI.

    • Mild and reversible AKI was tied to an increased risk for probable dementia and mild cognitive impairment in older adults with high cardiovascular risk, data show.

    "There has been increased recognition in recent years that AKI can have a sustained impact on health and long-term consequences, including incident or progressive chronic kidney disease, long-term mortality and myocardial infarction," Kristen L. Nowak, PhD, MPH, director of the clinical vascular physiology laboratory at the University of Colorado Anschutz Medical Camp division of renal diseases and hypertension in Aurora, Colorado, and colleagues wrote. In addition, "CKD is associated with high risk of mild cognitive impairment and dementia. It is also well accepted that acute cognitive dysfunction and delirium can occur with severe AKI as a result of uremic encephalopathy."

    pictures of brain scans in clinical setting The rate of mild cognitive impairment and probable dementia was higher in adults with AKI. Image: Adobe Stock.

    Researchers conducted a retrospective cohort study of 8,148 U.S. Adults at high risk for cardiovascular disease and who were enrolled in the Systolic Blood Pressure Intervention Trial between 2010 and 2013. The goal was to determine whether AKI increased the risk of cognitive decline. Patients' average age was 68 years, 65% were men and 28% had prevalent CKD. Patients with baseline systolic blood pressure between 130 mmm Hg and 180 mm Hg with a blood pressure goal of less than 120 mm Hg were placed in the intensive treatment group, and those with a goal of 140 mm Hg were counted as the standard treatment group. No patients had prior diabetes or stroke, and researchers incorporated all major antihypertensive medication classes to achieve desired blood pressure goals.

    The incidence rates of mild cognitive impairment, probable dementia and its composite were higher among 270 patients who had an AKI event, according to the findings. In a fully adjusted model, the researchers found a link between AKI and probable dementia (HR = 1.72; 95% CI, 1.07-2.75) and the composite outcome of probable dementia and mild cognitive impairment (HR = 1.43; 95% CI, 1.01-2.04).

    "These results suggest that cognitive function should be monitored following AKI in this patient population," the researchers wrote. "Further research is needed to continue to elucidate the mechanisms by which AKI may increase susceptibility to cognitive impairment."

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