What is the etiology of Zepbound (possibly referring to a medication, assuming it's a brand name, however no known medication with this name exists, possibly a misspelling) and new onset cardiomyopathy (disease of the heart muscle)?

From the Guidelines

Zepbound has not been directly linked to causing cardiomyopathy, and other etiologies such as pre-existing cardiovascular disease, hypertension, coronary artery disease, viral infections, genetic factors, or other medications should be considered as the primary cause of new onset cardiomyopathy. When evaluating the etiology of new onset cardiomyopathy in a patient taking Zepbound, it is essential to consider various factors that may contribute to the development of cardiomyopathy. According to the study by 1, cardiomyopathy can be caused by various factors, including cardiotoxicity from chemotherapy agents such as anthracyclines, trastuzumab, and certain anti-vascular endothelial growth factor inhibitors.

• Other potential causes of cardiomyopathy include:
  • Pre-existing cardiovascular disease
  • Hypertension
  • Coronary artery disease
  • Viral infections
  • Genetic factors
  • Other medications The study by 1 highlights the importance of considering drug-induced atrial fibrillation as a potential cause of cardiomyopathy, particularly in patients taking certain medications such as alkylating agents, anthracyclines, and tyrosine kinase inhibitors.
• However, it is crucial to note that Zepbound, a GLP-1/GIP receptor agonist, has not been directly linked to causing cardiomyopathy, and current evidence suggests that GLP-1 receptor agonists may actually improve cardiovascular outcomes 1. Any patient developing cardiac symptoms while on Zepbound should undergo a thorough cardiac evaluation, including echocardiography, cardiac biomarkers, and possibly cardiac MRI, to determine the true cause of cardiomyopathy.
• The decision to temporarily discontinue Zepbound during this evaluation should be made in consultation with both endocrinology and cardiology specialists based on individual risk-benefit assessment. It is also important to consider the measurement of cardiac biomarkers, such as troponin, and longitudinal strain measured by echocardiography, as these may provide better prediction for the development of cardiotoxicity than other biomarkers or imaging alone 1.

From the Research

Etiology of New Onset Cardiomyopathy

• The causes of cardiomyopathy are heterogeneous and can be separated into primary (genetic, mixed, or acquired) and secondary categories 2.
• Dilated cardiomyopathy can be genetic or acquired and typically presents with classic symptoms of heart failure with reduced ejection fraction 2, 3.
• Restrictive cardiomyopathy is much less common and often associated with systemic disease 2.
• New onset cardiomyopathy can be caused by various factors, including myocarditis, exposure to alcohol, drugs or other toxins, and metabolic or endocrine disturbances 3.
• In about 35% of patients, genetic mutations can be identified that usually involve genes responsible for cytoskeletal, sarcomere, and nuclear envelope proteins 3.

Diagnosis and Treatment of Cardiomyopathy

• Diagnosis of cardiomyopathy includes electrocardiography and echocardiography testing, as well as complementary diagnostic procedures such as cardiac magnetic resonance and genetic testing 2, 4.
• Treatment may include appropriately staged therapy for heart failure, appropriate activity restriction, evaluation for implantable cardioverter-defibrillator placement, and consideration of heart transplantation in refractory cases 2.
• Guideline-based heart failure medication and device therapy reduces the frequency of heart failure hospitalizations and improves survival 3.
• Treatment with angiotensin-converting enzyme inhibitors and/or beta blockers can delay progression of cardiomyopathy in patients with Duchenne muscular dystrophy 5.

Zepbound

• There is no available information on "Zepbound" in the provided studies, suggesting that it may be a misspelling or a non-existent term.