Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and glucose-dependent insulinotropic polypeptide/GLP-1 receptor agonists (GIP/GLP-1 RAs) are emerging as effective treatments for obesity and cardiometabolic disease. This study evaluated physician perceptions of the safety and efficacy of semaglutide and tirzepatide through a questionnaire administered to 165 attending physicians specializing in internal or family medicine, with 122 responses received. Physicians reported an average patient weight loss of 9.22%, significantly lower than the 14.9% and 18.5% reported in the STEP and SURMOUNT trials, respectively. Estimated side effect rates (32.62%) were markedly lower than trial-reported rates (89.7% and 80.5%), while estimated discontinuation rates (8.59%) exceeded trial data. Cardiovascular benefits were perceived by 48.4% of physicians in diabetic patients, consistent with random guessing, and by only 39.3% in nondiabetic patients, significantly below random guessing expectations. These results highlight discrepancies between physician perceptions and clinical evidence, suggesting gaps in understanding regarding these agents’ efficacy and safety profiles. Addressing these gaps could enhance physician knowledge, patient adherence, and clinical outcomes.

Introduction: Chest pain is one of the most common and high-risk presentations in the emergency department (ED), necessitating timely and accurate evaluation to prevent adverse cardiovascular outcomes. Coronary Computed Tomography Angiography (CCTA) has emerged as a promising non-invasive modality with high sensitivity (90–100%) and a negative predictive value (98–100%) for ruling out significant coronary artery disease (CAD), as evidenced by trials such as ROMICAT II and ACRIN-PA. Despite its expanding role in ED triage, further evaluation of its impact on patient-centered outcomes is essential. Methods: A systematic review was conducted in accordance with PRISMA guidelines. Studies published between January 2010 and June 2025 were identified from PubMed, Embase, and the Cochrane Library. Eligible studies included randomized controlled trials and prospective cohort studies assessing CCTA in ED patients with suspected acute coronary syndrome (ACS), compared with alternative diagnostic strategies, and reporting outcomes, including diagnostic accuracy, time to diagnosis, ED discharge rates, hospital admissions, and cost-effectiveness. Results: Twenty-three studies comprising over 60,000 patients were included. CCTA in low- to intermediate-risk patients significantly reduced diagnostic time (up to 54%), increased early ED discharges, and lowered unnecessary admissions. It consistently demonstrated excellent diagnostic performance, with pooled sensitivity ≥90% and near-perfect negative predictive value. Economic evaluations showed reduced costs due to shorter ED stays and less downstream testing. Challenges included radiation exposure, contrast use, and incidental findings. Conclusions: CCTA enhances ED efficiency and safety in ACS evaluation, offering accurate CAD exclusion and resource optimization. Future studies should explore its long-term cost-effectiveness and integration into high-sensitivity troponin protocols.

Background: Cardiac computed tomography angiography (CCTA) has evolved beyond anatomical stenosis assessment into a comprehensive platform for cardiovascular and cardiometabolic risk stratification. Advances in postprocessing and artificial intelligence now enable automated quantification of multiple imaging biomarkers from a single acquisition, including coronary plaque characteristics, CT-derived fractional flow reserve (FFR-CT), epicardial adipose tissue (EAT), pericoronary adipose tissue (PCAT), and hepatic steatosis. Purpose: In this narrative review, we synthesize current imaging biomarkers, evaluate their individual and combined prognostic value, and propose a conceptual multimarker framework for cardiovascular risk stratification—recognizing that several domains remain investigational and are not yet ready for routine, biomarker-guided management. Key findings: Quantitative plaque analysis identifies high-risk features — including low-attenuation plaque, positive remodeling, and napkin-ring sign — that independently predict major adverse cardiovascular events (MACE) beyond stenosis severity. FFR-CT carries a Class 2a guideline recommendation for intermediate lesions and demonstrates superior vessel-level diagnostic accuracy compared with SPECT and comparable performance to PET in head-to-head trials. EAT volume and density independently predict incident coronary heart disease, atrial fibrillation, and all-cause mortality across large prospective cohorts. Pericoronary fat attenuation index (FAI) reflects local coronary inflammation, independently predicts MACE after adjustment for conventional risk factors and coronary calcium, and decreases in response to high-dose statin therapy. Hepatic steatosis, identifiable from the same noncontrast acquisition used for calcium scoring, is associated with a 64% increased odds of cardiovascular events in a meta-analysis exceeding 34,000 adults and predicts both plaque progression and high-risk plaque features in longitudinal registries. Emerging multimarker models combining these domains demonstrate incremental discriminatory value beyond individual imaging biomarkers or traditional clinical risk scores. Conclusion: CCTA provides a pragmatic, multidimensional framework that integrates anatomic, functional, inflammatory, and metabolic information from a single noninvasive examination. While standardization, longitudinal validation, and equitable representation in research cohorts remain unresolved challenges, ongoing advances in AI-driven image analysis and multiomics integration may, if validated in prospective outcome studies, support the future translation of quantitative CCTA imaging biomarkers into more personalized cardiovascular care.