Scott Webb (Host): On today's podcast, we're discussing obesity and the obesity epidemic in America and how it relates to heart disease and heart attacks. We'll also be discussing weight loss drugs and whether or not they hold the keys to not only losing weight for these patients, but if they also might prevent heart disease and heart attacks.

And joining me today is Dr. Vincent DeFilippi. He's a cardiothoracic surgeon at Salinas Valley Health and a nationally recognized expert in the field of cardiac surgery. He's board certified in Cardiothoracic and General Surgery by the American Board of Thoracic Surgery. He served as the director of cardiac

surgery for Salinas Valley Health and was recently appointed to serve on the clinical advisory panel at the Department of Healthcare Access and Information. Dr. DeFilippi's expertise is essential as the Department of Health Care Access and Information expands its Cardiovascular Outcomes Reporting Program for all cardiovascular services in the state of California.

 This is Ask the Experts, the podcast from Salinas Valley Health. I'm Scott Webb. Doctor, thanks so much for your time today. We're going to talk about prescription weight loss drugs and whether or not they can prevent heart attacks. And I'm sure that's something that's on the minds of folks. And in all cases, of course, we always want folks to speak with their own providers, but it's great to have your expertise today. And I know that obesity is an epidemic. So, tell us how obesity relates to heart disease.

Dr. Vincent DeFilippi: There's multiple risk factors for getting heart disease. And one of them is obesity, which can be either from poor diet or from lack of exercise, which are the key issues.

Host: Just wondering if it's accurate to say that once a patient meets with you, is it because something has happened, have they had some sort of heart event? And, you know, what are you seeing now that you weren't seeing 10, 20 years ago when it comes to obesity and/or heart disease?

Dr. Vincent DeFilippi: So when they come to see me, clearly, things have progressed pretty far. They're going to need heart surgery. But the thing that's been interesting, especially in this community, is that the obesity and then subsequent diabetic consequences of poor diet and exercise have now hit younger and younger patients. So, what we're seeing is that patients are getting diabetes when they're maybe even teenagers. So by the time they're 40, they've already had diabetes for 25 years. And so now, they have heart disease that's so advanced that they might need heart surgery. In the past, maybe people would get diabetes when they're 50. Twenty-five years later, they're 75. So, we're seeing much younger patients coming in because this is starting to affect younger and younger people.

Host: Let's just talk about in general, how can folks improve their health? What can we do?

Dr. Vincent DeFilippi: Well, there's a lot of things that we know to decrease your chances of having heart disease, things like we've talked about the diabetes and the exercise, watching cholesterol. There are certain things we can't change, whether you have a family history or not. You know, there's some testing we can do to monitor it. Interestingly, a study just came out recently that in the younger patients, especially ones that have issues with mental health, are having increased incidence of heart disease and heart attacks. So things that can help with anxiety, or things like yoga or medications may also help reduce heart disease by improving your mental health.

Host: That's really fascinating. Let's talk about nutrition. You know, doctor, there are so many fad diets out there and just walking the aisles sometimes at the store, my head starts spinning. What's your recommendation? What do you tell patients when we talk about healthy foods, Blue Zones, all that good stuff?

Dr. Vincent DeFilippi: So, Blue Zones is an interesting concept because it goes further than just the diet. It's a whole sort of way of life. It's some of the other things we talked about. But, you know, as you age, having purpose and walking more and all of the things that in those Blue Zone cultures have are what reduces the incidence of heart disease.

The thing that is difficult is that with diets now, there's so many diets, like you said. And, you know, we just know the studies come out that the typical Mediterranean diet is still the most recommended overall for heart health and keeping away from certain foods are still recommended. But as far as physicians go, and as far as patients go, coming in and getting monitored for these things, getting their cholesterol checked, getting their sugars checked, getting their blood pressure checked, is going to be the best way to monitor the effects of how their diet and exercise are doing.

Host: You touched on this a little bit earlier, but let's roll up our sleeves a little bit more and talk about, you know, diabetes drugs are being prescribed to people who want or need to lose weight. And then, there's a study that concluded that some weight loss drugs help prevent heart attacks. We're going to need your expertise here. What are your thoughts on this? Maybe including side effects, things like that?

Dr. Vincent DeFilippi: So, the side effects are the biggest problem with these new drugs. Basically, they're almost always gastrointestinal side effects. They make it to a point where people just can't tolerate the drug because it's so severe. The other issues that we're not sure about, because these drugs haven't been long enough for any long-term sequelae of these drugs. It appears that if you stop taking them after you've lost the weight, that the weight does come back. So just like a lot of these other medications, whether it's for blood pressure for diabetes, or for whatever, they do tend to be a lifetime commitment. The other issue with these drugs are, presently, they're still very expensive, access is still difficult to getting them. And so, there's still some unknowns as well.

Host: Yeah. Wondering about these drugs, should they be used in people without a history of heart attack or stroke to help them avoid a heart event?

Dr. Vincent DeFilippi: So, these new drugs that have come out, the semaglutides, they increased weight loss in people by both increasing insulin, which is the problem with diabetics, and by decreasing your urge to eat because of the hormones that they produce that make you feel not hungry. So initially, the drug was only used for diabetes. And then, it was found that people were losing weight and now, it's also being used for people to lose weight, but nobody was sure what effect that might have on heart disease.

So recently, a study came out showing that in people who do have cardiovascular disease, that if they take this drug, even if they don't have diabetes, which is what the drug initially was used for, that you reduce your chance of having a heart attack or a stroke. So, that's still the unknown. This study came out just a couple of weeks ago, and it was only done in people who have both obesity and a history of some cardiovascular disease. So, it was a very specific population of people. But the interesting piece of it was that they didn't have to have diabetes and they got helped. Because since the drug is initially prescribed and FDA approved for diabetics, now using it in patients who don't have diabetes and not just to lose weight, but to help reduce their chances of having cardiovascular events is the big takeaway from that. The next step is going to be to start to look at does it actually help people that don't have any history of heart problems to help them from ever getting heart problems.

Host: Yeah, right. To be determined, but would be pretty interesting and pretty mind-blowing if it turns out that is in fact what happens or that's in fact the way it would work. Any red flags from your perspective when it comes to prescribing these medications to patients who want to lose weight?

Dr. Vincent DeFilippi: Well, I think the issue is who should be getting them? Just because you want to lose weight, 5 pounds, 10 pounds, that's probably not the person that needs to be taking this medication. I think that using them appropriately in the appropriate population is the way to go right now. I think that people are very excited about not having to do everything that they've tried to do for so many years to get that final 5 or 10 pounds off isn't the right person to be taking the medication at this time.

Host: Yeah, I see what you mean. Good stuff today. I feel like we've just scratched the surface. I want to give you a chance here at the end. Final thoughts and takeaways about prescription weight loss drugs, the impact that they're having now and may have in the future.

Dr. Vincent DeFilippi: I think that there's a lot for us to still learn about these drugs. Like I said, as far as long-term sequelae, we don't know, but it's very encouraging. I think the fact that we know that diabetes and obesity, but specifically diabetes, is a very bad disease when it comes to heart issues and cardiovascular issues, the inflammatory response to them, and that a drug that can really help with that really feels like it's going to have legs, and it's really going to be helpful in helping prevent all these younger patients that are coming in and help prevent all the people that have issues with being able to diet appropriately. And hopefully, it'll reduce all the procedures that we need to do right now to keep people going.

Host: Keep people going. Yeah, absolutely. Really appreciate your time today. I feel like there's going to be a second part of this, maybe part two, where we talk about the results more and what it all means. But for today, thank you so much and you stay well.

Dr. Vincent DeFilippi: Thanks for having me.

Host: And for more information go to salinasvalleyhealth.com. And if you found this podcast to be helpful, please be sure to tell a friend, neighbor or family member. And subscribe, rate and review this podcast, and check out the entire podcast library for additional topics of interest. This is Ask the Experts from Salinas Valley Health. I'm Scott Webb. Stay well, and we'll talk again next time.