Percentage and main features of patients referred to a cardiac rehabilitation program who would have an indication for a GLP1 receptor agonist based on the SELECT trial criteria
Authors: Torres Marques J , Moranta Ribas M E , Ferrer Oliver J A , Trias Oliver C , Gomez Monjo M J , Pardo Martin L , Company Nicolau M , Plomer Torres A , Gomis Fernandez P L , Monleon Castello M S , Garcia Gutierrez M E , Romano F , Vidal Barcelo P , Buen Ruiz M C , Ripoll Vera T 
Published: June 2024

Abstract

Background
Recently published, SELECT trial has shown that semaglutide, a glucagon-like peptide-1 (GLP1) receptor agonist, reduces the risk of adverse cardiovascular events in patients 45 years of age or older who had preexisting cardiovascular disease and a body-mass index of 27 or greater but no history of diabetes (1).

Purpose
Our purpose is to calculate the percentage of patients attending a cardiac rehabilitation (CR) program who would have indication of a GLP1 receptor agonist based on the SELECT trial eligibility criteria. And to describe their main features and their weight and body mass index change during a CR program without specific pharmacological management for obesity.

Methods
Retrospective observational study. We reviewed data of all the patients who attended our CR unit since April 2014 to September 2023. Obesity management in our CR unit includes dietary counselling and structured centre-based exercise program. GLP1 agonist receptors are not financed by our country's public health system for the indication of body weight loss. Body mass index (BMI) was calculated as weight in kilograms divided by the square of the height in meters. To compare related means, we used the paired samples t-test.

Results
Since 2014, 692 patients have been treated in the CR program.
92% of them had preexisting coronary disease (638).
90% of patients with coronary disease were 45 years old or older (575). Their mean BMI was 29.0. Only 17,2% of them had a normal BMI. 45,4% were overweight and 37,4 were obese.
64% of patients with coronary disease and 45 years of age or older had a BMI of 27 or more (361).
66% of patients with coronary disease who were 45 years of age or older and had a BMI of 27 or more were non diabetic (238).
Sumarizing, 34,3% (238 of 692) of patients who attended the CR program would have had indication of a GLP1 receptor agonist based on the SELECT trial eligibility criteria.
Their mean age was 58,6 (SD=8,0) years, 84% men, their mean initial BMI was 31,5 (SD=4,6), mean initial weight 90,7 (SD=13) kg. They had acceptable levels of adherence to the Mediterranean diet measured in Medas-14 Predimed test (9,2 SD=2,2).
There was a statistically significant improvement in MI and weight loss during the CR program in these patients (31,5 -SD=3,8- vs 31,1 -SD=3,9- kg/m2 ,p 0,002 and 90,7 -SD=13,1- vs 89,7 -SD=13,6- kg, p:0,002). But both average improvement in BMI and weight loss were of small amount (0,3kg/m2 -SD=1,5- and 0,9 kg -SD=4,4-). Average percentage of body weight loss was 1,0% (SD=4,7). Only 11% of patients achieved a 5% or more of weight loss.

Conclusions
34,3% of patients attending a CR program would have indication of a GLP1 receptor agonist based on the SELECT trial eligibility criteria.
The mean percentage of body weight loss was of small amount (1%) in a CR program based on behavioural counselling and structured exercise. GLP1 receptor agonists could help to improve these results.