GLP-1 receptor agonists as an opportunity for patients with atherosclerotic cardiovascular disease as well as obesity in Germany

Abstract Background A GLP-1 receptor agonist may reduce the incidence of cardiovascular events in patients with atherosclerotic cardiovascular disease (ASCVD) who are overweight or obese but do not have diabetes mellitus according to the recent SELECT trial testing semaglutide. Similar studies with other incretin mimetics are currently being carried out. Purpose The number of hospitalized patients in Germany who could potentially be treated with GLP-1 receptor agonists is being investigated. Methods Of all inpatients aged ≥18 years in German hospitals in 2022, a sample of 10% was randomly selected and analysed for the occurrence of obesity with and without diabetes mellitus in the context of ASCVD. Obesity was defined as BMI ≥30kg/m². Results The 10% sample included 1,446,420 patients with a mean age of 63.2 years and a proportion of male gender of 47.5%. 92,539 patients presented with obesity and 247,691 with type 2 diabetes mellitus. 229,619 patients had ASCVD. 19,984 patients were obese and had type 2 diabetes mellitus without ASCVD. 71,148 non-obese ASCVD patients had type 2 diabetes mellitus. There were 8,368 patients with a combination of all three diseases. Overall, 34.6% of the ASCVD patients had a type 2 diabetes mellitus. 7,256 obese patients had ASCVD without diabetes mellitus, which corresponds to 3.2% of ASCVD patients. Therefore, a total of 37.8% of patients with ASCVD also had type 2 diabetes mellitus, obesity or a combination thereof. Among those with ASCVD and obesity without diabetes mellitus, 4,292 (59.2%) presented with an obesity grade I, 1,708 (23.5%) with a grade II, 873 (12.0%) with a grade III, and 383 (5.3%) with an unspecified level. Conclusion In this German inpatient sample, GLP-1 receptor agonists may be a therapeutic option for 37.8% of ASCVD patients – 34.6% because of concomitant type 2 diabetes and 3.2% because of concomitant obesity even in the absence of type 2 diabetes mellitus. This represents approximately 6% of all inpatients in Germany.