Expensive Dr. Cocarach: My 66 -year -old husband just lately obtained a prognosis of coronary heart failure with preserved ejection fraction. It has 5 toes, 7 inches excessive and weighs 270 kilos. He’s treating his fluid retention with 100 mg of furosemide per day. It additionally has gentle and unrelated sleep apnea.
He wish to strive one of many LPG-1 medicine to lose some weight, however I fear the attainable pancreatitis attributable to their alcohol consumption. (Child 6-7 whiskies a day). My major care physician instructed me that some folks get sick quite a bit in the event that they drink alcohol whereas consuming this treatment.
In tonight’s information, there was a narrative about some individuals who succeeded with combating alcohol dependancy whereas utilizing these medicine, and we had additionally heard that they helped with the apnea of sleep. In his opinion, would it not be useful and protected for him to strive one? – BV
ANSWER: Coronary heart failure is a decreased capability of the guts to offer all of the blood that the physique wants, whereas sustaining low pressures within the coronary heart to let the blood of the lungs correctly drain. Coronary heart failure with the preserved ejection fraction (HFPEF) signifies that the guts can tighten correctly, however its predominant drawback is to calm down at low strain. Excessive fill pressures trigger a fluid backup, resulting in a quantity overload (additionally referred to as fluid retention).
Whereas furosemide and different diuretics might help with the signs, drugs which have had a really vital impression on HFPEF administration have been drugs that had been initially used for diabetes, SGLT2 inhibitors reminiscent of picagliflozine and GLP-1 agonists such because the semaglutido (in folks with HFPEF and weight problems). These medicine assist folks reduce weight and it has additionally been proven that they cut back hospitalization attributable to coronary heart failure.
Pancreatitis has been knowledgeable in individuals who take GLP-1 medicines. Nevertheless, the chance is low, roughly 1 per 1,000 individuals who take the treatment for a yr. It’s not nonetheless sure that the chance of pancreatitis is bigger with these drugs in comparison with different medicines. Nevertheless, I doubt to make use of them in an individual with a historical past of pancreatitis. I’d cease and by no means restart a GLP-1 drug if pancreatitis develops throughout therapy.
There are early and suggestive information that GLP-1 medicine cut back alcohol cravings. A big cohort of individuals with alcohol consumption dysfunction who take semaglutida or liraglutida had a decreased threat of hospitalization attributable to alcohol consumption or different substances.
A special examine confirmed a lower in alcohol consumption throughout therapy with semaglutida or tirzepatida. These outcomes haven’t been confirmed with a randomized scientific trial, however specialists are optimistic. The alcohol within the quantity that’s taking is poisonous to the guts, though alcohol -related coronary heart failure normally happens with a decreased ejection fraction, not preserved.
Given the extreme weight problems of her husband (an BMI of 42.three is extreme), the good thing about a LPG-1 agent in her weight, coronary heart failure and alcohol exceeds the potential injury of pancreatitis. Lastly, now there are sturdy information to indicate that in folks with apnea and weight problems of sleep, therapy with a LPG-1 agent can cut back sleep apnea.
The extreme unrelated sleep apnea is a reason for coronary heart failure. Charles Dickens knew in 1836 and wrote a really clear description in his first novel, “the posthumous paperwork of the Pickwick Membership.”
Dr. Roach regrets that he can not reply particular person letters, however will incorporate them within the column at any time when attainable. Readers can ship questions by electronic mail to toyourgoodhealth@med.cornell.edu or ship mail to 628 Virginia Dr., Orlando, FL 32803.