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• Two classes of diabetes drugs may also improve cardiovascular and kidney disease outcomes in people with or without diabetes.
• In a meta-analysis involving more than 70,000 patients with diabetes, SGLT2 inhibitors reduced the risk of heart attack, stroke, and kidney disease progression.
• When paired with a GLP-1 drug, the benefit increased.

Two classes of diabetes drugs show health benefits far beyond improving blood sugar. When used together, their effects are even more evident.

For individuals with type 2 diabetes, SGLT2 inhibitors lower blood sugar by preventing the kidneys from reabsorbing glucose; the excess sugar is instead excreted through urine. But they do more than that. Large trials suggest that SGLT2 inhibitors reduce the risk of kidney disease, heart attack, and stroke not only in patients with type 2 diabetes, but also, those without.

If you’ve been following the trajectory of another well-known class of diabetes drugs, this might sound familiar.

The health benefits of GLP-1 drugs, the class of diabetes and obesity medications that includes Ozempic, Wegovy, Mounjaro, and Zepbound, have also grown to include improving outcomes for cardiovascular disease, heart failure, and chronic kidney disease.

New research published this week in The Lancet Diabetes & Endocrinology now indicates that both classes of drugs used together may yield even more protective benefits than individually.

“What we found was clear and additional benefits of SGLT2 inhibitors when used in combination with GLP-1 receptor agonists, benefits on cardiovascular disease, benefits on kidney disease progression, and also no increased risk of side effects or safety issues when used in combination,” Brendon Neuen, PhD, a Clinical Associate Professor of Medicine at Royal North Shore Hospital in Sydney, Australia, and co-author of the study told Healthline.

Robert A. Gabbay, MD, PhD, Chief Scientific and Medical Officer for the American Diabetes Association, lauded the study, saying, “This adds to the growing body of evidence showing the benefit of these two important classes of medicines and that their benefits can be additive.”

Gabbay and the ADA were not involved in the research.

Kidney and CVD benefits of SGLT2 inhibitors

Neuen and his team conducted a meta-analysis of 12 randomized, double-blind, placebo-controlled trials — the “gold standard” for research trials. The analysis included data from more than 70,000 patients with diabetes. A small cohort of those patients, about 3,000 (4.2%), were being prescribed a GLP-1.

The researchers were curious whether or not the cardiovascular and kidney protective effects of the SGLT2 inhibitors would persist across the available data, and how the addition of a GLP-1 would alter those effects.

Not only did the protective benefits of the SGLT2s persist with or without the presence of a GLP-1, but when the two were paired, the benefits were even greater.

The study examined a myriad of serious health issues that are known comorbidities of type 2 diabetes. These outcomes include the risk of major cardiovascular events (heart attack and stroke), hospitalization for heart failure, or death from cardiovascular disease.

Chronic kidney disease progression was also explored, which the team defined as a 40% or more decline in eGFR (a standard measurement of kidney functioning), kidney failure, or death due to kidney functioning.

Compared to a placebo, an SGLT2 by itself reduced the risk of heart attack and stroke by 11% and hospitalization for heart failure or cardiovascular death by 23%. The effects on kidney disease progression were even more pronounced: an SGLT2 yielded a reduced risk of 33% compared to a placebo.

For each outcome, the addition of a GLP-1 resulted in an additional small reduction in risk. For cardiovascular disease-related hospitalizations and kidney disease progression, a GLP-1 further reduced risk by about 2%. For major cardiovascular events, a GLP-1 nearly doubled the protective effects, reducing risk by an additional 10%.

Safety and tolerability were also consistent when an SGLT2 was used individually or paired with a GLP-1, meaning there was not an increased number of adverse events when the drugs were used together.

“These data provide the strongest evidence that we have yet that using these two medications in combination is not only safe but highly effective and is likely to improve clinical outcomes for people with type 2 diabetes who have cardiovascular kidney disease,” said Neuen.

A new era of diabetes management

The study is likely to grab the attention of doctors and healthcare organizations who are still evaluating and creating guidelines for these two relatively novel classes of drugs. The FDA  first approved SGLT2 inhibitor, Invokana (canagliflozin), in 2013. GLP-1 drugs have been available for nearly 20 years, but have only recently taken the industry by storm due to blockbuster drugs like Ozempic and Zepbound capturing the attention of the public.

“In the new era of diabetes management where we have available medications such as GLP-1 receptor agonists and SGLT2 inhibitors, the goal is to understand which patient could benefit most from which treatment or treatment combination,” Mona Mashayekhi, MD, PhD, an Assistant Professor of Medicine in Diabetes, Endocrinology and Metabolism at the Vanderbilt University Medical Center who wasn’t affiliated with the study, told Healthline.

For patients with type 2 diabetes who are at risk for or already have comorbidities like kidney disease, heart failure, or cardiovascular disease, it appears there is a new world of potential in these drugs. Even for patients without diabetes, the benefits of GLP-1s and SGLT2s are a promising development.

“These medications are now recommended in people with heart failure and kidney disease, even if they do not have diabetes, because they have clear and important, clinically important benefits in preventing kidney failure and heart failure outcomes,” said Neuen.

The bottom line

In a meta-analysis involving more than 70,000 patients with diabetes, SGLT2 inhibitors improved outcomes for cardiovascular events like heart attack and stroke, hospitalizations, and kidney disease progression.

When an SGLT2 inhibitor was paired with a GLP-1 (the class of drugs that includes Ozempic and Mounjaro), there was an even greater reduction without any additional safety issues.

Experts told Healthline that the findings will help to better inform doctors about treating patients with certain comorbidities, including kidney disease and heart disease.

In this blog post, Jenny, from Hampshire, shares the story of her daughter Layla and her struggle with whooping cough at 3 weeks old.

• A new report found that a common screening technique used to assess the risk of endometrial cancer may be less effective in Black people.
• Pelvic transvaginal ultrasonography misses a significant percentage of cancer risk cases in Black females.
• The most accurate way to detect endometrial cancer in Black females is through a tissue biopsy.

A new report found that a common screening technique used to assess the risk of endometrial cancer (EC) may be less effective in Black people.

The study, published in JAMA Oncology in June, discovered that pelvic transvaginal ultrasonography (TVUS) led to false negatives in a portion of Black females who actually had EC.

TVUS, which uses sound waves to produce a picture of the inside of the pelvis, is routinely recommended to females experiencing postmenopausal bleeding, which is a symptom of EC. 

If the TVUS reveals that the individual has a thicker endometrial thickness (ET), they should also get a tissue biopsy to screen for EC.

Some Black females with EC have a relatively thin endometrial thickness — as a result, they don’t get a biopsy, and the cancer is missed. 

With EC, early detection is crucial. 

“Since we know that ultrasound assessment is not always accurate in Black women, other screening modalities are essential for early cancer detection, including symptom awareness and advocacy,” Elena Ratner, MD, MBA, a gynecologic oncologist at Yale Cancer Center and Smilow Cancer Hospital, told Healthline. 

Many cancers were missed on ultrasounds in Black females

The report evaluated the health data of 1,494 Black individuals who underwent pelvic ultrasonography with an ET measurement before a hysterectomy.

Of the group, 210 had EC. In addition, 78% had fibroids, 71% had vaginal bleeding, and 57% had pelvic pain. 

Of the 210 who had EC, about 11% had an ET that was below the diagnostic threshold for detection (4 mm).

The study found that roughly 9.5% of cancers detected in Black females were detected below the threshold of 4 mm, and 3.8% were in people who had an ET less than 3 mm. 

An estimated 11.5% of the cancers would have been missed because the people had a relatively thin ET.

The findings suggest the most accurate way to identify EC in Black females is through a tissue biopsy.

Diana Pearre, MD, a board certified gynecologic oncologist at The Roy and Patricia Disney Family Cancer Center at Providence Saint Joseph Medical Center in Burbank, CA, says that the lead researcher of the study, Dr. Kemi Doll, has significantly added to the scant research that’s been done surrounding health inequities in the diagnosis and treatment of endometrial cancer. 

“The main takeaway I believe she wants us to understand is that we cannot rely simply on the image we see on an ultrasound report to determine whether to biopsy a patient with postmenopausal bleeding,” Pearre said.

Why TVUS may be less reliable for detecting cancer in Black people

In many patient populations, TVUS is an effective way to measure ET and provide a risk assessment for EC.

“It is often used to determine whether patients should get a biopsy of the internal lining of the uterus and make sure there are no cancerous or precancerous changes in the lining,” Amer Karam, MD, a gynecologic surgeon with Stanford Medicine, says.

However, the procedure doesn’t appear to be as reliable in Black females. 

Prior research has shown that Black females with postmenopausal bleeding are less likely to get an endometrial biopsy. 

A study published in 2019 revealed that Black females are more likely to get false negative transvaginal ultrasounds compared to white females. 

“In publications, ultrasound findings of being below a certain endometrial thickness threshold rule out the possibility of endometrial cancer. In Black women, that does not appear to be the case,” Ratner said.

According to Karam, the majority of studies examining the accuracy of TVUS have been conducted in mostly white patients.

The researchers of the new report suspect that the decreased visibility of the cancers in Black females and the increased prevalence of fibroids may make the cancer harder to detect via TVUS alone.

“One other factor not examined in the current study is the higher prevalence of aggressive types of endometrial cancer that present with thinner linings among Black patients,” Karam said.

Biopsies can help detect a greater percentage of cancers

Pearre suspects that many physicians will be surprised to see these new findings.

“I hope they take this study into account and refer patients to gynecologists when they report bleeding regardless of how thick the inner lining of their uterus is,” Pearre said.

The researchers suggest that a tissue biopsy should always be done to provide an accurate diagnosis of EC.

According to Pearre, endometrial sampling is the cornerstone of EC diagnosis.

“If a patient reports bleeding after menopause or even heavy bleeding prior to menopause, endometrial sampling is probably the next best strategy in their workup,” Pearre said.

The bottom line:

A new report found that a common screening technique used to detect endometrial cancer risk may be less effective in Black people.

Pelvic transvaginal ultrasonography misses a significant percentage of cancer risk cases in Black females.

The most accurate way to detect endometrial cancer in Black females is through a tissue biopsy.

• In a real-world study, Mounjaro showed greater weight loss compared to Ozempic.
• Patients taking Mounjaro were more likely to hit weight-loss benchmarks and drop more pounds overall.
• The study is the first to compare the two drugs head-to-head in a real-world setting using healthcare data.

Eli Lilly’s Mounjaro trumps Novo Nordisk’s Ozempic in the first real-world comparison of weight loss in patients with obesity.

According to a new study in JAMA Internal Medicine, Mounjaro (tripeptide) showed better results across multiple weight-loss benchmarks and overall weight loss compared to Ozempic (semaglutide). 

Both are part of a class of drugs known as glucagon-like peptide receptor agonists (GLP-1), which are indicated for the treatment of type 2 diabetes and obesity.

GLP-1 drugs work by mimicking natural hormones in the gut and brain that control blood sugar and appetite. They also cause weight loss by slowing digestion and imparting feelings of fullness and satiety.

Ozempic and Mounjaro are both FDA-approved for the treatment of type 2 diabetes, but are frequently used “off-label” for obesity.

The drugs are sold under different trade names, Zepbound (tirzepatide) and Wegovy (semaglutide), when indicated for the treatment of obesity.

Prior trials have shown patients taking Ozempic lost as much as 16% of their total body weight. Mounjaro showed even more impressive results, with some patients losing more than 20%.

However, due to differences in how the trials were conducted, they cannot be directly compared.

New real-world data now suggests that Mounjaro is, in fact, the more effective of the two for weight loss. 

“This data is informative and reinforcing because it supports our experiences in real-world clinical practice — people lose more weight with tirzepatide than with semaglutide,” Beverly Tchang, MD, an endocrinologist, Spokesperson for the Obesity Society, and Assistant Professor of clinical medicine at Weill Cornell Medicine, told Healthline. Tchang wasn’t affiliated with the research.

Patients taking tirzepatide 3 times as likely to achieve weight loss of 15% or more

The study found that across a one-year time period, patients taking tirzepatide were more than twice as likely to achieve a weight loss of 10% or greater and three times as likely to achieve a weight loss of 15% or greater compared to semaglutide.

Total weight loss at various intervals, including three, six, and 12 months, was also greater among those taking tirzepatide. The gap between the two drugs also increased with time. At three months, the average weight loss for tirzepatide was 5.9% compared to semaglutide’s 3.6%. By one year, patients taking tirzepatide lost more than 15% of their body weight, while those taking semaglutide lost about 8%.

“As a practicing cardiologist and researcher, having the most timely data to inform patient care is paramount,” Ty Gluckman, MD, Medical Director at the Center for Cardiovascular Analytics, Research, and Data Science (CARDS) at Providence Heart Institute, and an author on the paper, told Healthline.

“Because tirzepatide was only approved by the FDA in mid-2022 for type 2 diabetes, the ability to rigorously analyze its use (on- and off-label) for a broad population of patients with overweight or obesity, not just a subset captured in insurance databases, has the power to greatly improve our understanding of how these agents are being used in everyday practice and the effect that they’re having,” said Gluckman.

To conduct their study, researchers at Truveta, a healthcare data and analytics company that currently includes 30 health systems across the US, tapped into electronic health records and prescriber data.

They identified adults with overweight or obesity who began taking either Ozempic or Mounjaro for the first time between May 2022 and September 2023. They could not have previously been prescribed a GLP-1 drug to be included in the study.

In total, more than 40,000 patients met criteria for the study who had taken one of the two drugs. After matching patients taking tirzepatide to characteristically similar individuals taking semaglutide, the total cohort remaining was 18,386. The average age of patients in the study was 52. The cohort was predominantly female (70%) and white (77%). About 12% of the cohort was Black and 2% were Asian.

More than half of the patients included in the study were living with type 2 diabetes.

No difference in drug safety

Researchers also observed whether either drug resulted in more adverse health events. 

GLP-1 drugs are known to be associated with common gastrointestinal effects, including nausea, diarrhea, and vomiting. However, more serious complications have also occurred, including bowel obstruction or ileus, which is potentially fatal.

Both Ozempic and Mounjaro resulted in a similar amount of adverse events, according to the study.

Moderate-to-severe outcomes that were observed included bowel obstruction, gastroparesis, pancreatitis, and cholelithiasis (gallstones).

“Gastrointestinal side effects of these medications have been widely reported as well, but we didn’t find a difference in the rates of moderate to severe gastrointestinal adverse events between the two medications,” Tricia Rodriguez, PhD, a scientist at Truveta Research, and lead author on the paper, told Healthline.

The study also yielded some other significant findings. Consistent with other clinical trials, weight loss was greater among patients without type 2 diabetes. The reasons for these effects are still unclear. 

Additionally, more than 50% of patients in both the tripeptide group and semaglutide group stopped taking their medication within one year.

Researchers theorize that this could be linked to a number of different factors, including the cost and accessibility of the medications or side effects. The study doesn’t conclude why the discontinuation rate is so high but notes that more research needs to be done in this area.

The bottom line

In a first real-world comparison using healthcare data, Mounjaro (tirzepatide) outperformed Ozempic (semaglutide) across numerous weight-loss benchmarks.

Patients taking Mounjaro were two times as likely to achieve a weight loss of 10% or greater and three times as likely to achieve a weight loss of 15% or greater.

The safety profile of both drugs was similar in terms of adverse gastrointestinal events during the study period.

• Genetic profiling can identify those most at risk of developing prostate cancer.
• A new study estimates how early interventions in at-risk populations might impact early death from the disease.
• They find that lifestyle changes, like reducing smoking and maintaining a healthy weight, in these individuals could prevent thousands of prostate cancer deaths in the United States. 

A new study finds there may be a better way to identify people at risk of dying due to prostate cancer.

According to the study published July 3 in JAMA Network Open, measuring genetic risk can help identify people with an increased risk of dying from prostate cancer. 

Researchers argue that this type of screening can help physicians target individuals with an increased mortality risk and encourage them to make lifestyle changes.

The scientists calculate that this approach could cut prostate cancer deaths in at-risk individuals by one-third.

Who is at risk of dying from prostate cancer?

Prostate cancer causes almost 400,000 deaths each year, globally. Although it mostly affects older adults, according to the authors of the new study, around one-third of men who die from prostate cancer die before 75.

One way to identify men at risk of prostate cancer is by calculating their polygenic risk score (PRS). In short, this method helps scientists spot gene variants that increase an individual’s risk of developing prostate cancer or dying from it.

According to the new study, men whose PRS is in the top 10% have a 40–50% chance of developing prostate cancer in their lifetime. The study researchers say this would be a good population to target with lifestyle advice that may reduce the severity of the disease.

Decreasing your prostate cancer risk

Risk factors for prostate cancer can be nonmodifiable, in other words, individuals have no control over them. Or risk factors can be modifiable, meaning changes in lifestyle can decrease the risk of developing cancer.

Healthline spoke with Trevor Royce, MD, a radiation oncologist, adjunct faculty with the Department of Radiation Oncology at Wake Forest School of Medicine, and senior medical director at the precision medicine company Artera. 

Royce pointed out that non-modifiable risk factors include:

• Age: The older a man is, the greater the chance of getting prostate cancer.
• Race and ethnicity: African American men are more likely to be diagnosed with prostate cancer.
• Genetic factors: Genetic risk factors may put some men at higher risk of prostate cancer.

However, some risk factors are modifiable. These include:

• avoiding smoking
• maintaining a healthy weight
• regular exercise

There is some evidence that men with a higher risk of developing prostate cancer — for instance, those with a higher PRS — may benefit most from lifestyle interventions.

1 in 3 early prostate cancer deaths may be preventable 

To investigate whether prevention can help reduce the mortality risk for people with genetic risk, the scientists accessed information from almost 20,000 people in the U.S. and Sweden and followed them for around 20 years. All subjects were prostate cancer-free at the start of the study.

The researchers also accessed their genetic data and information about their lifestyle and diet. By combining smoking status, exercise levels, body weight, and dietary factors, the researchers gave each individual a healthy lifestyle score. They also calculated their polygenic risk score (PRS) which factors in genetic markers for prostate cancer.

During the study’s follow-up, there were 444 deaths from prostate cancer. The analysis showed that both genetic and lifestyle factors increased the risk of death from prostate cancer.

Death before 75 was considered an early death, and deaths after 75 were deemed late.

Compared with individuals with a low PRS, those with a high score had a 3-fold increased risk of early death from prostate cancer and a 2-fold increased risk of late death from prostate cancer.

In further analyses, the authors showed that an unhealthy lifestyle only appeared to increase the rate of prostate cancer death among men with a higher PRS. In other words, lifestyle factors seemed less important for people with a lower genetic risk.

The lifetime risk of prostate cancer death was lowest for men with a lower genetic risk: 0.6%–1.3%. Men in the top 25% of PRS scores had a risk of 3.1%–4.9%. Overall, the highest risk was in participants with both a high PRS and an unhealthy lifestyle.

When the researchers analyzed early cancer deaths — before the age of 75 — they found that most of these deaths (88%) were individuals with a high genetic risk score.

They also estimate that lifestyle modifications could prevent many of these deaths:

“Importantly, we estimated that approximately one-third of early prostate cancer deaths among men in this group may be preventable through behaviors associated with a healthy lifestyle.”

The importance of lifestyle factors in prostate cancer

Healthline spoke with Jeffrey S. Yoshida, MD, the medical director of urologic surgery at City of Hope Orange County in Irvine, CA.

“We know that the best way to stop cancer is to prevent it in the first place. Certain lifestyle factors can impact your risk of developing cancer and adopting healthy habits has been shown to reduce the risk of prostate cancer,” Yoshida said.

“I can’t emphasize enough how essential a healthy lifestyle is for good prostate health,” he continued. “Research has shown that nutrition plays a key role in reducing prostate cancer risk.”

He suggests reducing intake of processed meat and saturated fat, while upping fruit and vegetable intake.

Limitations and the future

The current study does have certain limitations. For instance, they only had information about participants’ lifestyles at the time they joined the study — people’s habits and diets can change significantly over the years.

Speaking with Healthline,  S. Adam Ramin, MD, board-certified urologist, urologic oncologist, and medical director of Urology Cancer Specialists in Los Angeles, CA, said, “this study does not address how lifestyle changes can reduce the chances of developing prostate cancer.” Rather, it focuses on reducing the chance of dying from prostate cancer.  

Ramin said he is positive about the findings:

“Studies like the above help screen for those men with higher risk prostate cancer and help lower the risk of death from these cancers. They also support our efforts in promoting healthy eating, exercising, and lifestyle changes for our patients.”

We also spoke with Przemyslaw Twardowski, MD, who was not involved in the study.

Twardowski is a board-certified medical oncologist, a professor of medical oncology, and director of clinical research in the Department of Urology and Urologic Oncology at Providence Saint John’s Cancer Institute in Santa Monica, CA.

“It is assumed that addressing these modifiable lifestyle factors would reduce the risk of developing potentially fatal prostate cancer,” he told us, “although at this point, this has to be treated as a viable hypothesis and not a conclusive proof,” Twardowski said.

However, he believes these results will “be helpful in earlier detection of cancer by more aggressive screening of high-risk individuals but also lifestyle intervention.” As important as genetics are,” he continued, “modifiable factors also play a role, and addressing them can be emphasized in our patient counseling.”

The issue of accessibility and the path ahead

The cost of genetic tests may also be an issue if oncologists decide that this testing should be rolled out more broadly. “In general, though, genetic testing is becoming widely accessible and affordable as prices of these tests have come down dramatically in recent years,” Twardowski told Healthline.

However, according to Ramin, currently “there is no known standardized test that specifically tests for the 400 genes that are examined in the PRS. At this point, PRS is more of a research tool than a validated laboratory test.”  

Overall, the authors conclude that “Implementing interventions among men at increased genetic risk may substantially reduce the number of early deaths due to prostate cancer.” 

In the meantime, Royce provided this advice: “One of the most important things men can do is talk to their doctors about their prostate cancer risk and go for their recommended screenings.” 

“Early detection can impact cancer survival,” he said.

Takeaway

A recent study finds that the vast majority of early prostate cancer deaths are in people with a high genetic risk. They also conclude that around one-third of these deaths could be avoided with lifestyle changes, including a healthy diet, exercise, and avoiding tobacco.

• Semaglutide, the active ingredient in Ozempic and Wegovy, is associated with a rare blinding disease, according to new research.
• The condition, known as non-arteritic anterior ischemic optic neuropathy (NAION), causes sudden blindness due to a lack of blood flow to the optic nerve.
• Despite the findings, the study does not demonstrate a causal link between the drug and NAION.

Semaglutide, the blockbuster drug used in Ozempic and Wegovy, has been linked to a rare blinding disease.

Patients with type 2 diabetes and obesity who take semaglutide appear to be at greater risk of nonarteritic anterior ischemic optic neuropathy (NAION) compared to those prescribed a non GLP-1 drug. NAION is a condition that causes sudden blindness, typically in one eye, due to a lack of blood flow to the optic nerve. There is no known treatment for the condition.

The findings, presented in the journal JAMA Ophthalmology, are compelling, but experts caution that they are preliminary and observational. The findings do not demonstrate a causal link between the drug and NAION. Nonetheless, with the massive popularity of semaglutide, it is important for both doctors and patients to be aware of the potential risk.

“I am going to start mentioning this as a caution to a patient, but I’m not going to say that because you’re obese and you have diabetes and you’re taking this medication, that you’re going to go blind,” Yin Allison Liu, MD, PhD, an Associate Professor of Neuro-Ophthalmology at University of California Davis, told Healthline. She wasn’t affiliated with the study.

NAION is an elusive condition with little known about its exact cause.

“Ischemic optic neuropathy is very common in older diabetic patients that have vasculopathic risk factors, although its pathogenesis is completely not understood,” Nicholas J. Volpe, MD, a neuro-ophthalmologist and Chairman of the Department of Ophthalmology at Northwestern University’s Feinberg School of Medicine, told Healthline. Volpe wasn’t involved in the research.

Up to 8 times greater risk of rare blinding condition

Researchers at Massachusetts General Brigham utilized patient data to look for any retrospective correlation between semaglutide and NAION over one year. They investigated two cohorts, each representing one of the FDA-approved indications for semaglutide: obesity and type 2 diabetes. In total the records of nearly 17,000 patients were included in the study. 

Of those patients, 710 had type 2 diabetes and 979 were overweight or obese.

Among patients with type 2 diabetes, the average age was 59 years old and more than half were female. The age of patients in the overweight or obese group skewed younger, an average of 47 years old, and was 72% female.

The study authors asked a simple question: were patients in this group more or less likely to develop NAION if they were prescribed semaglutide or a non-GLP-1 medication?

They found a clear signal.

Patients with type 2 diabetes were more than four times as likely to have a diagnosis NAION; patients with obesity were more than eight times as likely.

Over the one-year period, there were 17 incidences (8.9%) of NAION among those taking semaglutide in the diabetes cohort, but only six (1.8%) among those taking a non-GLP-1 drug. The results were even more pronounced among overweight and obese patients: 20 NAION events (6.7%) occurred in those taking semaglutide, compared to just 3 (0.8%) for those who did not. Whether these events were connected to semaglutide or were confounded by the higher risks associated with obesity and type-2 diabetes is not clear.

Volpe reiterated to Healthline that although the findings demonstrate an association, much more research is needed.

“It does not establish causality. It does not establish danger. It does not do anything besides call attention to this and the potential need for us to think about this and study it more carefully,” he said.

Patients and healthcare providers should discuss the risks and benefits of any medication in the context of an individual’s personal circumstances and medical history.

“If I were a patient that wanted to take this type of medication, I would not hesitate based on this study, thinking that I’m going to go blind,” said Volpi.

What is NAION?

NAION (nonarteritic anterior ischemic optic neuropathy)is a rare blinding disease that causes sudden blindness in one eye, often after waking. It is caused by a lack of blood flow (ischemia) to the optic nerve, which connects the eye to the brain. The condition is rare, only occurring in 2-10 per 100,000 people. It is the second most common cause of blindness due to optic nerve damage behind glaucoma.

The cause or pathogenesis of NAION is still not well understood, although it is generally believed to be associated with vasculopathic risk factors including diabetes, hypertension, and high cholesterol.

“Despite knowing about this disease for 75 years, it was first described or recognized in the 1950s, we as neuro-ophthalmologists have never firmly established that only people with high blood pressure get this disorder or only people with diabetes,” said Volpe.

The most significant risk factor for NAION is an anatomical condition known as “disc-at-risk” or cupless optic nerve: when the structure of the eye itself causes crowding of the optic nerve fibers.

“With this condition, the blood flow or oxygen delivery into the eyes can be relatively at risk when we have other confounding factors,” said Liu.

More controversial evidence has suggested that other common medications, including antihypertensives (specifically, those taken before bedtime) and erectile dysfunction drugs known as PDE5 Inhibitors may also be associated with NAION.

While a serious complication, NAION is a rare condition and little is known about the causes. “We know about as much about the pathogenesis of this condition today as we did 31 years ago when I did my neuro-ophthalmology fellowship,” said Volpi.

The bottom line

In an observational retrospective study, researchers found that patients with type 2 diabetes or obesity who were taking semaglutide were more likely to develop a rare blinding condition than those taking a non-GLP-1 drug.

The condition, known as non-arteritic anterior ischemic optic neuropathy (NAION), causes sudden blindness in one eye, often upon waking in the morning.

Experts told Healthline that the findings are still early and do not demonstrate causality. Patients should consult with their healthcare provider about the risks and benefits of prescribed medications.

• New research finds that people with type 2 diabetes, who take semaglutide, may be less likely to develop certain forms of cancer.
• The researchers studied 13 cancers linked to obesity. They found that people on semaglutide had a decreased risk of developing 10 of these cancers.
• Experts say that more research is needed.

New research published July 5 in the journal of the American Medical Association has found evidence that the use of semaglutide medications, like Ozempic and Wegovy may help reduce the risk of obesity-associated cancers in people with type 2 diabetes.

Reduced risk of 10 obesity-linked cancers

In the study, researchers studied 13 cancers linked to obesity.

They found people taking semaglutide had less risk of developing 10 of these obesity-associated cancers. These cancers included esophageal, colorectal, endometrial, gallbladder, kidney, liver, ovarian, and pancreatic cancer, plus meningioma and multiple myeloma. 

However, semaglutide was not linked to a significantly reduced risk of developing thyroid, stomach, or breast cancer.

Yoni Resnick, PharmD, the director of pharmacy clinical services with New England Cancer Specialists, says that these results are encouraging.

“It’s exciting to see that, there might be…some smoke as it relates to these medications, potentially reducing the risk of some cancers that have historically been statistically related to obesity,” Resnick said.

The study, which pulled from the medical data of 1,651,452 patients across 13 years, compared those with type 2 diabetes who had been prescribed a GLP-1, insulin, or metformin.

Jennie Stanford, MD an obesity medicine physician for InteliHealth, who previously worked within the University of Pittsburgh Medical Centre system, said we’re just starting to understand how GLP-1 drugs can impact your health.

“I think we’re at the tip of the iceberg when it comes to understanding the benefits of the GLP-1 receptor agonists,” Stanford said. “As we learn more and more about what they’re able to do, I think we’ll be able to see possibilities for using them in dementia, in obesity-associated cancers and other medical problems that are linked back to the same underlying mechanism.”

One of the study’s authors, Lindsey Wang, a student at the Center for Science, Health, and Society, Case Western Reserve University School of Medicine, Cleveland, Ohio said that people using semaglutide did not have a lower risk among all obesity-associated cancers.

“Most notably, we saw a decrease [of] significant risk across most gastrointestinal cancers. So, that goes all the way from your esophagus down to your colon. This is pretty interesting because these cancers usually have a poor prognosis after you are diagnosed with it,” Wang said. “Something that did surprise us a little was that we found no association between using these GLP-1 RA’s [receptor agonists] and your breast cancer risk, which was contrary to our initial expectation.”

Up to 65% reduced risk of certain cancers

The research team found that people with type 2 diabetes on GLP-1 drugs compared to those on insulin had reduced risk of multiple cancers including the following.

• 65% reduced risk of gallbladder cancer
• 63% reduced risk of meningioma
• 59% reduced risk of pancreatic cancer
• 53% reduced risk of a type of liver cancer called hepatocellular carcinoma.
• 48% reduced risk of ovarian cancer
• 46% reduced risk of colorectal cancer
• 41% reduced risk of multiple myeloma
• 40% reduced risk of esophageal cancer
• 26% reduced risk of endometrial cancer
• 24% reduced risk of kidney cancer.

The team behind the study concluded that more research, including pre-clinical and clinical trials, are needed to build on these findings

Stanford says that one finding that jumped out at her was the decreased risk of gallbladder cancer. 

“We know that obesity is a huge factor in gallbladder disease,” Stanford said. “So think about that in terms of gallstones and gallbladder function, but it stands to reason that that would occur for gallbladder cancer as well.”

Wang, an undergraduate student says the research group she belongs to at Ohio’s Case Western University are now looking at GLP-1 agonists and their role when it comes to cancer outcomes.

GLP-1 drugs to combat cancer?

Resnick says that these findings, should they be confirmed by further research, may make a difference in his oncology practice’s high risk group. He also says that these GLP-1 medications are becoming a more common talking point among oncologists. 

“You can leverage this kind of data that says, obesity is directly associated with…this group of cancers,” Resnick said. “By offering this type of weight reduction medication as compared to other types of medications… You’re reducing the risk for cancer, thus improving the overall health of the population, cutting healthcare costs, all of those well-known talking points.”

Takeaway

New research published in has found evidence that the use of semaglutide medications, like Ozempic may help reduce the risk of obesity-associated cancers in people with type 2 diabetes.

• Teva Pharmaceuticals is launching the first-ever generic GLP-1 drug in the United States.
• Victoza, originally approved by the FDA in 2010 for diabetes, is part of the same class of drugs that includes Ozempic, Wegovy, and Zepbound.
• Experts say they welcome the generic formulation but expressed concerns about price and effectiveness.

Teva Pharmaceuticals announced the launch of a generic form of Victoza (liraglutide), the first-ever generic GLP-1 drug to be made available in the United States.

Glucagon-like peptide-1 receptor agonists (otherwise known as GLP-1s or GLP-1 RAs) are a class of incretin drugs that mimic the body’s natural hormones to help treat diabetes and obesity. Other blockbuster drugs in this class include semaglutide (sold under the brand names Ozempic and Wegovy) and tirzepatide (sold under the brand names Mounjaro and Zepbound.

The latter is considered a “dual agonist” because it activates two receptors: GLP-1 and GIP.

The drugs have proven to be exceptionally effective, particularly for weight loss, with some patients losing up to 25% of their body weight. They’ve also been shown to have many other beneficial effects, including lowering A1C and improving cardiovascular outcomes.

However, the popularity of the drugs has spiraled out of control at times, leading to shortages and supply chain issues in the US and abroad. The common practice of using diabetes medications like Ozempic and Mounjaro “off label” for cosmetic weight loss has led to some diabetes patients being forced to ration their supplies or switch drugs entirely.

“By launching an authorized generic for Victoza, we are providing patients with type 2 diabetes another option for this important treatment…We are providing the first generic GLP-1 product to the US marketplace, demonstrating once again our ability to sustain a generics powerhouse,” Ernie Richardsen, a Senior Vice President of Teva Pharmaceuticals, said in a statement.

The arrival of a GLP-1 generic drug provides reasons to be hopeful for doctors and patients alike, but there are also caveats.

How doctors are reacting to Teva’s announcement

Dr. Caroline Apovian, MD, a Professor of Medicine at Harvard Medical School and the co-director of the Center for Weight Management and Wellness at Brigham and Women’s Hospital, told Healthline that the approval was “another step in the right direction.”

But, she quickly followed that with some immediate concerns about cost.

“My big question for Teva is how much are you going to charge for it?” she said.

Dr. Sun Kim, MD, an Associate Professor of Endocrinology at Stanford Medicine, told Healthline that while she’s excited about an additional treatment option, she also has concerns.

“The prices that I have seen for Teva’s liraglutide are high, especially given that liraglutide is injected once daily (vs. weekly) and generally inferior to higher doses of liraglutide and tripeptide weekly,” she told Healthline.

Healthline contacted Teva about the cost of their generic but did not receive a response.

According to The Guardian, the wholesale acquisition cost (WAC) of the generic will be 13.6% lower than Victoza.

A two-pack of injection pens is estimated to cost around $470, while a three-pack will cost around $700. A spokesperson for Teva told The Guardian that “WAC pricing does not account for the price discounts offered to customers and is not reflective of our final net price.”

How effective is Victoza compared to other GLP-1 drugs?

Another notable issue pointed out by experts is that Victoza isn’t as effective as novel GLP-1s. The FDA originally approved Victoza for diabetes in 2010, followed by Saxenda (also liraglutide) for obesity in 2014.

“I think no one would dispute that liraglutide, while effective for lowering glucose and weight, is inferior to higher doses of semaglutide and tirzepatide,” said Kim.

Head-to-head clinical trials have consistently demonstrated that the latest batch of GLP-1 drugs perform better.

The STEP 8 randomized clinical trial compared semaglutide and liraglutide and found that patients taking semaglutide lost significantly more weight (15%) than those taking liraglutide (6%).

Tirzepatide has proven even more effective in a clinical trial, with patients losing 20% of their body weight.

The SUSTAIN 10 trial, another head-to-head trial between semaglutide and liraglutide, found that while both lowered A1C, semaglutide had better results, resulting in a decrease of 1.7% compared to 1% for liraglutide.

While shortages of other GLP-1 drugs remain, Teva’s generic Victoza is a welcome addition to the market.

However, for some patients, the price tag and lower effectiveness compared to novel agents could remain a barrier for many.

The bottom line

The first-ever generic GLP-1 drug is being launched in the United States by Teva Pharmaceuticals.

GLP-1 drugs, which include the blockbuster diabetes and obesity medications Wegovy and Zepbound, are touted for their effectiveness but are expensive and often in short supply.

Experts told Healthline that while they welcome the generic GLP-1, they still have concerns about its cost and overall effectiveness compared to newer GLP-1 drugs.

• An investigational drug called lerodalcibep lowered low-density lipoprotein (LDL) cholesterol, or “bad” cholesterol, by 50% or more, a new study showed.
• The year-long clinical trial included people who were unable to lower their LDL cholesterol enough using statins.
• Lerodalcibep is not yet approved by the FDA, but two other drugs in this class were approved by the agency in 2015.

An investigational drug lowered low-density lipoprotein (LDL) cholesterol, or “bad” cholesterol, in people who were unable to lower their LDL cholesterol enough using statins.

Researchers say the results support the use of lerodalcibep as a treatment for people with existing cardiovascular disease or who are at high or very high risk of cardiovascular disease.

Most people in the study who received once-monthly injections of lerodalcibep were able to reduce their LDL cholesterol level by 50% or more. They also met target levels for LDL cholesterol recommended by current guidelines.

The results of the clinical trial were published July 3 in JAMA Cardiology.

Statins and other cholesterol-lowering meds

Around 10% of American adults have high cholesterol, according to the Centers for Disease Control and Prevention. 

However, only about half who could benefit from a cholesterol-lowering medicine are currently taking one, the agency said. This increases their risk of heart attack, stroke and other major cardiovascular problems.

Medications available for treating high cholesterol include statins, which have been available since the 1980s, and the newer PCSK9 inhibitors.

PCSK9 inhibitors target a protein in the liver called proprotein convertase subtilisin kexin 9, or PCSK9. 

“PCSK9 inhibitors improve the ability of your liver to take up cholesterol particles from the blood and process them,” said Yu-Ming Ni, MD, cardiologist and lipidologist at MemorialCare Heart and Vascular Institute at Orange Coast Medical Center in Fountain Valley, Calif. “The result is a significant reduction in cholesterol levels.”

The FDA approved two PCSK9 inhibitors in 2015: alirocumab (Praluent) and evolocumab (Repatha). Both are given by injection under skin, every 2 to 4 weeks. Lerodalcibep is not yet approved by the FDA.

“[Approved PCSK9 inhibitors] work really well to lower cholesterol. Sometimes even better than the statins that we typically give for cholesterol lowering,” Ni told Healthline.

Also, “patients don’t get too many side effects from PCSK9 inhibitors,” he said. “The only downside is that they can be a little expensive for some patients, depending on insurance.”

PCSK9 inhibitors may be used for patients who have been unable to lower their cholesterol enough using statins. In this case, a PCSK9 inhibitor would be prescribed alongside a statin.

However, people who can’t tolerate the side effects of statins may take only a PCSK9 inhibitor, said Ni.

Reductions in cholesterol and other lipids

The new study included 922 adults who were taking the highest dose of a statin that they could tolerate, but still hadn’t lowered their LDL cholesterol to the target level recommended by guidelines.

The average age of participants was 65 years and 45% were female. Overall, 88% of people finished the clinical trial.

People were randomly assigned to receive either monthly injections of lerodalcibep or a non-acting placebo for 52 weeks.

After one year, 90% of people who received lerodalcibep reduced their LDL cholesterol by 50% or more, and met the recommended LDL cholesterol targets.

On average, people who received lerodalcibep reduced their LDL cholesterol by 56% after 52 weeks and 69.5% after 60 weeks. They also saw reductions in apolipoprotein B, apolipoprotein(a) and triglycerides.

“This is crucial, as both apolipoprotein B and high lipoprotein(a) levels are a significant risk factor for cardiovascular disease,” said Jacqueline Hollywood, MD, cardiologist with Hackensack University Medical Center, “and we currently have limited treatment options for lipoprotein(a).”

The study results also show that lerodalcibep was well tolerated, with similar adverse events as the placebo.

The main difference was that reactions at the injection site occurred more frequently in people who received lerodalcibep (6.9%) compared to those in the placebo group (0.3%). These reactions were mild or moderate in severity.

Larger, long-term studies needed

Given the benefits of FDA-approved PCSK9 inhibitors, Ni said it is good to see a new drug that works in a similar manner as those. 

“In this trial, we can see that lerodalcibep lowers LDL cholesterol by a very similar amount [as those other drugs],” he said.

He pointed out that prior studies of FDA-approved PCSK9 inhibitors show that these drugs can also reduce the risk of cardiovascular events such as heart attack and stroke.

However, he cautions that additional longer-term studies would be needed to show whether lerodalcibep has a similar effect on cardiovascular risk.

“Cholesterol-lowering drugs that were very promising have surprised us before,” said Ni. “So I think it’s really important that we continue on to that next step [of additional studies].”

Hollywood highlighted that one limitation of the study is that it included a relatively small number of participants. In spite of that, people in the study had “a wide range of cardiovascular disease risk factors,” she told Healthline, “suggesting the drug could benefit a diverse population.”

One group that the drug may help are people with atherosclerosis, a condition in which plaques build up in the arteries, which can increase the risk of heart attack and stroke. 

By lowering cholesterol and inflammation, the drug may prevent the formation of new plaques, said Hollywood, although additional studies are needed to confirm this potential benefit.

“Overall, the study provides promising evidence for the potential of lerodalcibep in cardiovascular disease treatment,” she said.

Takeaway

In a year-long clinical trial, participants were randomly assigned to receive either the PCSK9 inhibitor lerodalcibep or a non-acting placebo. People in the study were unable to lower their LDL cholesterol, or bad cholesterol, using statins.

The majority of people who received lerodalcibep saw reductions in their LDL cholesterol of 50% or more, and met LDL cholesterol targets set by guidelines.

People who received lerodalcibep also saw reductions in triglycerides and other lipids linked to an increased risk of heart attack and stroke. Lerodalcibep was well tolerated, with similar adverse effects as placebo. The main side effects of the drug were those that occurred at the injection site.

• A new study that tracked diet and cognitive ability across seven decades found that individuals with a healthier diet had better cognitive outcomes over time.
• The research involved a cohort of more than 3,000 individuals living in the UK born in 1946.
• The findings suggest that eating a healthy diet consistently in childhood and midlife is important to maintaining brain health in old age.

Diet is an important part of keeping your brain sharp as you age. New research indicates that the earlier you start eating healthy, the better.

In a first-of-its-kind study, researchers tracked the diet and eating habits of more than 3,000 individuals living in the UK and correlated it with their cognitive ability for seven decades. Those who had the highest-quality diets tended to have better cognitive ability over time compared to their peers who ate unhealthy diets.

“Cognitive decline can begin at age 65. But, there’s this long latency period, maybe 10 to 15 years prior to symptoms showing up, that those brain changes can already be happening. So our thinking was that diet much earlier than age 65 might be an important factor in what’s happening in our later life cognition. And our preliminary findings suggest that may be the case,” Kelly Cara, PhD, a recent graduate of the Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy at Tufts University and author of the research, told Healthline.

Cara presented her findings this week at NUTRITION 2024, the annual meeting of the American Society for Nutrition. The findings have not yet been published in a scientific journal and are considered preliminary.

Nonetheless, they are compelling and have practical implications for anyone concerned about maintaining brain health through diet. Experts say eating a diet rich in fruits and vegetables, fish, and whole grains — such as the Mediterranean diet — is a good place to start.

“The findings are consistent with similar studies and truly exemplify the importance that diet plays early in life to impact health (in this case, cognitive health) later in life,” said Kristin Kirkpatrick, MS RD, a nutritionist at the Cleveland Clinic, and co-author of Regenerative Health. She was not affiliated with the study.

Seven decades of research suggests healthy diets boost brain health

Cara’s work is based on data from the Medical Research Council’s National Survey of Health and Development, which has collected health and medical information from British citizens for nearly 100 years.

The research looked at one specific cohort of 3,059 individuals born in 1946 and evenly split between men and women. Those alive today are 78 years old and are still involved in the study.

Members of the cohort reported their dietary information at five separate points (age 4, 36, 43, 53, and 63). They also recorded cognitive ability, based on standard testing, seven times during that time span, between age 8 and 69.

“I have never seen any cohort that has dietary measures as early as this cohort, where diet was first assessed at age four, and then again throughout middle adulthood and now into the later life years,” said Cara.

Diet was assessed using a standard measure known as the Healthy Eating Index (HEI), which factors in 13 different components, including fruits, vegetables, whole grains, added sugars, and more to create a composite score of an individual’s diet. 

The assessments also used diaries and took place over several days rather than just a single day, creating a more detailed picture of an individual’s diet quality.

“We have a better indication of what that person’s habitual diet was at that time, instead of just a single measure taken, we’re able to kind of average across those multiple days, essentially to represent their diet in that decade,” said Cara.

Those who ate healthier diets, particularly in mid-life (during the survey at age 43), were associated with better cognitive ability through age 69. Specifically, 47% of those with the lowest quality diets also had the worst cognitive outcomes. On the other hand, 48% of individuals with the highest quality diet also had the best cognitive outcomes.

“This means general ability across language and memory and reaction time and visual processing, all of those things,” said Cara.

Foods and diet types that support a healthy brain

The right foods can support your brain health by reducing oxidative stress and slowing age-related mental decline.

“Brain” foods are often high in antioxidants and healthy fats, such as berries, nuts, and fatty fish, including:

• Pumpkin seeds
• Coffee
• Salmon
• Herring
• Sardines
• Walnuts

“Focus on colorful fruits and vegetables in the diet (aim for at least 6 colors every single day), a serving of leafy greens daily, and limit alcohol and ultra-processed foods. If you do not enjoy fatty fish, then consider omega-3 supplementation as well,” said Kirkpatrick.

Both Cara and Kirkpatrick emphasize the importance of diet as a whole rather than thinking about specific individual components. Eating healthy over a lifetime is about consistency and finding the right balance of what works for you.

“The idea here is that if I can be inspired by knowing that what I eat today actually does have an impact on how my future might look in terms of my cognition, that might be one more reason that I can say this is worth doing,” said Cara.

The bottom line

A first-of-its-kind study tracked dietary information and cognitive ability in more than 3,000 individuals across seven decades.

Researchers found that those who tended to have higher-quality diets also showed better cognitive ability across time compared to those with an unhealthy diet.

Experts say that thinking about diet holistically and eating a diet rich in fruits, vegetables, whole grains, and fish, such as the Mediterranean diet, is important for brain health.