IMPORTANCE OF BEING PATIENT-CENTRIC IN CARDIOVASCULAR-KIDNEY-METABOLIC CARE 

Cécile Gross and Mark Tunkel of Nemera discuss the company’s substantial portfolio of user-friendly, effective injectable devices available to meet the needs of patients with diverse chronic conditions.

Until recently, chronic conditions such as obesity, Type 2 diabetes mellitus, atherosclerotic cardiovascular disease, heart failure, chronic kidney disease and metabolic dysfunction-associated steatotic liver disease have been managed through separate treatments. Recent evidence reveals that these conditions share overlapping pathophysiologicalmechanisms and, therefore, treatment strategies. Today, they are recognised as interconnected disorders.

 In November 2023, the American Heart Association was the first to define cardiovascular-kidney-metabolic (CKM) syndrome as a “health disorderattributable to connections among obesity, diabetes, chronic kidney disease and cardiovascular disease (CVD), including heart failure, atrial fibrillation, coronary heart disease, stroke and peripheral artery disease. CKM syndrome includes those at risk for CVD and those with existing CVD”. As a result, the framework has expanded and can be called the Cardiovascular-Renal-Hepatic-Metabolic (CRHM) syndrome.

In parallel, new medications have demonstrated benefits across multiple similar conditions, improving both quality of life and clinical outcomes. Over the past five years, clinical trials have shown promising results for these therapies, such as glucagon-like peptide-1 receptor agonists (GLP-1 RAs), dual glucose-dependent insulinotropic polypeptide/GLP-1 RAs, sodium-glucose cotransporter 2 inhibitors and finerenone. More clinical trials are underway to further expand the indications of novel agents and to provide additional insight where current evidence is lacking. 

These significant advances in therapeutic approaches aim to expand treatment options and improve outcomes across the intertwined conditions that define the aforementioned syndromes. They also have the potential to transform the future of CKM/CRHM treatment moving towards patient-centred interdisciplinary care. 

GLP-1 RAs have become frontrunners in treating CKM/CRHM because they improve insulin resistance and glycemia, as well as reducing weight and CVD mortality. As obesity is a major driver of CKM syndrome, prevention and management of this condition is a clinical and public health priority. The WHO recognised the importance of this priority in its guideline on the use of GLP-1 medicines in treating obesity.

Beyond public health, public spending is also at stake. In the US, the total cost of chronic diseases due to obesity and being overweight has been assessed by the Milken Institute at 9.3% of GDP. Obesity is by far the greatest contributor to chronic disease burden, accounting for 47.1% of the total cost of chronic diseases nationwide...

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