JCL Roundtable. Obesity, Diabetes, and Liver Disease in Relation to Cardiovascular Risk

Area of Science:

• Cardiovascular Medicine
• Endocrinology
• Hepatology

Background:

• Metabolic risk extends beyond LDL cholesterol, encompassing obesity, diabetes, and fatty liver disease.
• Emerging therapeutic classes and diagnostic tools offer new avenues for risk reduction.

Purpose of the Study:

• To review current opportunities in preventive metabolic medicine.
• To discuss novel approaches for managing obesity, diabetes, and nonalcoholic fatty liver disease (NAFLD).

Main Methods:

• Expert roundtable discussion synthesizing current evidence.
• Review of randomized trial data for weight loss medications (phentermine/topiramate).
• Analysis of cardiovascular and renal outcomes for GLP-1 RAs and SGLT2 inhibitors.
• Assessment of diagnostic methods for liver fibrosis and NAFLD progression.

Main Results:

• Nutritional weight loss is individualized; pharmacotherapy (phentermine/topiramate) shows efficacy.
• GLP-1 RAs reduce cardiovascular events, HbA1c, weight, and blood pressure.
• SGLT2 inhibitors reduce heart failure and diabetic renal disease progression.
• NAFLD indicates atherosclerotic cardiovascular disease risk; fibrosis assessment is crucial.
• Some diabetes medications (GLP-1 RAs, SGLT2is, pioglitazone) can improve liver steatosis and steatohepatitis.

Conclusions:

• Preventive metabolic medicine is rapidly evolving with new therapeutic options.
• Clinical lipidologists need to integrate knowledge of these advances into practice.
• Comprehensive management of metabolic risk factors is essential for cardiovascular and hepatic health.