Episode 199: 199. weight gain semaglutide, Asthma, olive oil, Hypertension in pregnancy

Weight regain and cardiometabolic effects after withdrawal of semaglutide: The STEP 1 trial extension - Wilding - - Diabetes, Obesity and Metabolism - Wiley Online Library

“”””One year after withdrawal of once-weekly subcutaneous semaglutide 2.4 mg and lifestyle intervention, participants regained two-thirds of their prior weight loss, with similar changes in cardiometabolic parameters.”””

investigators assessed the changes in body weight among patients who were started on semaglutide therapy and subsequently stopped. The weight regain was accelerated immediately after treatment withdrawal and slowed at week 80. The results showed that while on semaglutide, participants lost an average of 17.3% of their baseline weight. However, once semaglutide was discontinued, participants regained 11.6% of lost weight by the 1-year follow-up. The net weight changes at week 120 were 5.6% (SD, 8.9) in the semaglutide arm and 0.1% (SD, 5.8) in the placebo arm.

Furthermore, cardiovascular in htn and glycemic category reverted back to baseline.

A life long drug and expensive.. this is sad but shows how chronic obesity is and it remains one of the biggest challenges in medicine

Papi A et al. Albuterol–budesonide fixed-dose combination rescue inhaler for asthma. N Engl J Med 2022 May 15; [e-pub]. (https://doi.org/10.1056/NEJMoa2203163. opens in new tab)

Global Initiative for Asthma (GINA) guidelines. opens in new tab recommend avoiding albuterol for all patients and using inhaled corticosteroids (ICS)/formoterol as a rescue inhaler. Although the National Asthma Education and Prevention Program (NAEPP) guidelines. opens in new tab have not gone that far, they do recommend using as-needed ICS/albuterol for mild asthma.

3100 adolescents and adults with uncontrolled moderate-to-severe asthma were randomized to either high- or low-dose albuterol/budesonide (180/160 µg or 180/80 µg) or albuterol alone (180 µg) as a rescue inhaler while continuing their current ICS or ICS/LABA (long-acting β-agonist) therapy. After 24 weeks, severe exacerbations requiring systemic steroids for rescue were significantly less common in both the low and the high-dose budesonide/albuterol group than in the albuterol group (annualized rate, 0.45 vs. 0.59).

This doesn’t tell us if ICS/fomoterol as rescue is better or worse than albuterol ICS but it does say or should remind us that albuterol alone is no longer indicated for maintenance for rescue for anything.

Ancel K, Keys M. How to Eat Well and Stay Well the Mediterranean Way. Coronary Artery Disease in Seven Countries. Circulation. 1975;41(4 Suppl):11-211.

1002 patients aged between 20 and 75 years with established coronary heart disease and randomly assigned them to either a Mediterranean diet or a low-fat diet. The follow-up period was 7 years.

The primary outcome was a composite of major CV events, myocardial infarction, revascularization, ischemic stroke, peripheral artery disease, and CV death.

To ensure that cost was not a barrier, extra-virgin olive oil was provided free of charge to the Mediterranean group (1 L per week per household), and free healthy food packs rich in complex carbohydrates were given to the low-fat group.

here were 111 events in the low-fat group and 87 events in the Mediterranean group, representing a 25% reduction in events in favor of the Mediterranean diet (HR, 0.745; P = ·040).

For men, the reduction was 33% (HR, 0.669; P = ·013). For women, there was no difference between the groups. However, there were only 175 women in the trial, so the lack of effect may be just due to the small number.

The lipid profile and glucose levels of the participants did not change significantly during the study—which is a huge knock for all the lipid hypothesis people out there.