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1.
CVD (and cancer) are the most common cause of mortality among patients with obesity [[90], [91], [92]]. Obesity directly increases the risk of CVD (e.g., via adiposopathic effects of epicardial fat), and indirectly increases the risk of CVD via the adiposopathic promotion of major CVD risk factors such as diabetes mellitus, high blood pressure, dyslipidemia, and thrombosis, as well as other conditions associated with increased CVD risk (e.g., sleep apnea, polycystic ovary disease, gestational diabetes, fatty liver) [3].
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2.
Weight reduction in patients with obesity often improves major CVD risk factors such as abnormalities in glucose, lipids, blood pressure and thrombosis, may have favorable effects on cardiac hemodynamics, and may reduce premature all-cause mortality [[93], [94], [95]]. Both weight reduction, and weight loss maintenance often present challenges in patients with overweight or obesity. Given that obesity is a multifactorial disease, overweight and obesity are best managed utilizing a multifactorial approach including nutrition, physical activity, motivational interviewing, behavior modification, pharmacotherapy, and possibly bariatric surgery [3].
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3.
No drug and dose having an indication to treat obesity has proven to reduce CVD events. Patients with obesity should undergo multifactorial CVD risk reduction (e.g., healthful nutrition and physical activity, smoking cessation, as well as optimal control of blood sugar, blood pressure, and blood lipids).
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4.
Glucagon-like peptide 1 receptor agonists (GLP-1 RA) have clinical outcome trial evidence to support CVD benefits in patients with diabetes mellitus (e.g., liraglutide, semaglutide), with some anti-obesity agents being evaluated in CVD outcomes trials in patients with obesity [3].
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5.
Metformin and sodium glucose transporter (SGLT)-2 inhibitors decrease CVD among patients with diabetes mellitus. While they do not have an indication as anti-obesity agents, metformin and SGLT2 inhibitors modestly reduce body weight in patients with and without diabetes mellitus. When accompanied by weight loss, many anti-obesity drugs reduce CVD risk factors (i.e., orlistat, liraglutide, naltrexone/bupropion, and phentermine/topiramate are not contraindicated in patients with cardiovascular disease) [3].
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6.
Little evidence supports phentermine & topiramate combination anti-obesity agent as increasing or decreasing CVD risk among patients with obesity [96].
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7.
Phentermine is contraindicated in patients with CVD [3]
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8.
Among patients with obesity, CVD and type 2 diabetes mellitus without congestive cardiomyopathy, initial drug treatments to consider include metformin and GLP-1 RA (e.g., liraglutide, semaglutide), and SGLT-2 inhibitors (e.g., empagliflozin, canagliflozin) [3].
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9.
Among patients with obesity, CVD, type 2 diabetes mellitus with mild congestive cardiomyopathy, initial drug treatments to consider in include metformin and SGLT-2 inhibitors [3].
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10.
Among patients with obesity, CVD, and without type 2 diabetes mellitus and without congestive cardiomyopathy, initial treatments to consider include liraglutide [3].
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