Common Cardiometabolic Diseases: Overview, Prevalence, and GLP-1 treatment Impact

Cardiometabolic diseases are a group of interconnected conditions that affect the cardiovascular system and metabolic health, including type 2 diabetes, heart disease, chronic kidney disease (CKD), and metabolic dysfunction-associated steatotic liver disease (MASLD) which are all becoming increasingly common, and can have both short- and long-term impact on healthcare costs and member treatment. There are many factors that increase the risk of developing cardiometabolic diseases and some examples are high blood pressure, obesity, high cholesterol, physical inactivity, and unhealthy eating. Many glucagon-like peptide receptor agonists, or GLP-1s have been approved to treat type 2 diabetes, which falls under this group of common (and often preventable) long-term health cardiometabolic conditions.

What does ‘cardiometabolic’ mean?

“Cardio” is shorthand for the overall cardiovascular system, which is made up of multiple elements—the heart, circulation systems, and blood vessels. “Metabolic” refers to a series of dysfunctions related to that system, like insulin resistance, metabolic dysfunction-associated steatotic liver disease (MASLD), or impaired glucose tolerance. 

The patient population is growing—roughly 11% of Americans have been diagnosed with diabetes, while 10% have been diagnosed with cardiovascular disease (i.e., coronary heart disease, heart failure, or stroke). Additionally, 1-in-8 US adults have reported taking a GLP-1 drug, with 6% continuing to take them.

The Impact of Cardiometabolic Conditions on Healthcare Costs

The sheer number of people currently living with cardiometabolic conditions or having a risk factor for cardiometabolic disease such as obesity is reshaping healthcare spend in a couple of ways. One, because of trending treatments, which can drive temporary spikes in demand for different pharmaceuticals. Those fluctuations, similar to the current, growing demand for drugs like Ozempic^®, are not necessarily predictable or sustainable, making for complex challenges around cost, formulary, benefit coverage, and prescription drug network management.

Brokers and employers are responsible for selecting the right healthcare plans to cover the workforce, as well as ensuring effective communication and management of healthcare benefits. 

Understanding cardiometabolic diseases and the role of GLP-1s will help you:

• Make informed decisions when choosing healthcare plans and negotiating PBM contracts
• Ensure employees have access to effective treatments that improve health outcomes and reduce long-term costs
• Navigate the complexities of formulary and network management to optimize healthcare benefits

Types of Cardiometabolic Diseases, Risk Factors, and Potential Treatment with GLP-1s

The diverse benefits of GLP-1s make them a valuable tool in managing cardiometabolic conditions. Understanding the specific types of related conditions and how they interconnect is crucial for designing benefits and drug coverage. 

Prediabetes and Diabetes

• Type 2 diabetes is the most common form of diabetes in the US, affecting more than 11% of the population. This is when blood sugar levels are high enough for a long period of time, which can cause issues in the eyes, kidneys and cardiovascular systems (heart and blood vessels). Type 2 diabetes can be managed through physical activity, a healthy diet, and medications if necessary. This is where GLP-1s play a key role in helping to control blood sugar levels and are FDA-approved for the treatment of type 2 diabetes in addition to lifestyle changes (healthy eating and physical activity). 

Heart Disease

Heart disease is another cardiometabolic condition and is the leading cause of death in the US—roughly 1 in 5 people in the US died from heart disease in 2021. The term “heart disease” actually encapsulates several heart conditions, with coronary artery disease (CAD) being the most common. Some other heart diseases include: 

• Heart attack—when a blood clot cuts off blood flow to the heart, resulting in part of the heart muscle dying
• Heart failure—when the heart doesn’t pump blood effectively enough to meet the body’s needs 
• Arrhythmia—when the heart has an irregular or abnormal rhythm
• Angina—when there isn’t enough blood flowing to the heart

While the risk of heart disease increases with age, that risk can be lowered with healthy lifestyle choices like regular exercise, managing cholesterol levels, having a healthy diet, avoiding smoking, limiting alcohol, and more. Additionally, once someone is affected by heart disease, there is a wide range of medications that can help manage symptoms, prevent blood clots, and also prevent a first or another heart attack. 

Several major clinical trials have demonstrated the benefits of GLP-1s on the heart, with many having an FDA-approved indication for reducing the risk of major cardiovascular events such as death caused by a heart attack or heart failure. 

Stroke

A stroke occurs when there’s a blockage of the blood supply to the brain, either from a clot or a blood vessel bursting. This results in brain damage since that part of the brain isn’t getting the blood and oxygen it needs. 

Every 40 seconds, someone in the US has a stroke, and every 3 minutes and 14 seconds, someone dies of stroke. Many of the cardiometabolic risk factors discussed below can increase the risk of a stroke, so managing hypertension, lowering bad cholesterol, and maintaining a healthy lifestyle are all ways to reduce your stroke risk.

GLP-1s have demonstrated in clinical trials that they reduce the risk of stroke by controlling blood sugar levels, promoting weight loss, lowering blood pressure, and improving lipid profiles, all of which directly benefit cardiovascular health.

Obesity

Obesity is a major issue in the US, affecting 1 in 5 children and 2 in 5 adults. It’s defined as having excessive fat accumulation, with a body mass index (BMI) over 30. Adults with obesity are at a higher risk of developing cardiometabolic diseases such as type 2 diabetes, heart disease, stroke, and more. All these complications come at a high cost (to the tune of approximately $173 billion per year in the US healthcare system). 

Treatment for obesity includes a healthy diet, regular physical activity, and adding medications if lifestyle changes are not enough. Some GLP-1s have been approved by the FDA for long-term weight management.

Dyslipidemia

Dyslipidemia is a cardiometabolic disease risk factor and refers to an imbalance in cholesterol levels. More specifically, it typically means someone’s low-density lipoprotein (LDL) levels—aka “bad” cholesterol—are too high while their high-density lipoprotein (HDL) levels—aka “good” cholesterol—are too low. 

If LDL levels are too high, it can lead to plaque buildup in the arteries and can increase the risk of heart disease or stroke. 

High cholesterol levels affect nearly 25 million Americans. It’s linked to other diseases mentioned already, and can be prevented with lifestyle changes (i.e., physical activity and healthy eating). 

It’s notable that while the primary role of GLP-1 and its analogs is in glucose metabolism and diabetes management, some research has shown beneficial effects on lipid levels and in treating dyslipidemia, especially in individuals that also have type 2 diabetes. However, as with any medical treatment, individual responses can vary, and the full extent of GLP-1's impact on dyslipidemia is still being studied.

Hypertension

Hypertension—also called high blood pressure—is when the pressure of the blood flowing through a person’s blood vessels is too high. This risk factor for cardiometabolic disease is incredibly common, with nearly half of American adults over 20 (over 122 million people) having increased blood pressure. GLP-1 treatments can have both direct and indirect effects on  cardiometabolic health, specifically the cardiovascular system, with a related impact on healthcare spend and outcomes. These include:

• Lowering blood pressure and improving blood vessel health
• Supporting better kidney health
• Decreasing the risk of heart attacks and strokes

Broker and Plan Sponsor Takeaways 

The rising prevalence of cardiometabolic conditions and increasing drug costs present significant challenges for pharmacy benefits management. However, there are strategies to ensure sustainable costs without compromising the value of prescription drug benefits.

Working with transparent partners is crucial for developing cost-effective plan designs. These partners should provide insights into pricing methodologies and cost-saving programs specifically tailored for cardiometabolic treatments, including GLP-1s. Access to clinical expertise is also vital, as it allows for guidance on the most effective and efficient treatment options.

By staying informed about GLP-1s, their role in treating cardiometabolic diseases, and their impact on healthcare costs, brokers, and employers can make more informed decisions when designing and managing healthcare benefits. This knowledge empowers you to advocate effectively for your group, balancing cost considerations with the need for comprehensive cardiometabolic care.

Join our upcoming webinar to learn more about GLP-1s, their role in treating cardiometabolic diseases, and what you need to know about their impact on modern healthcare and benefits management.