The diabetes-turned-weight-loss drug that has taken the world by storm in recent years, semaglutide, has been shown to reduce major adverse cardiac events by 20%.1 This was demonstrated in non-diabetic patients who were obese or overweight and had cardiovascular disease (CVD).
The Food and Drug Administration (FDA) first granted approval of semaglutide as a treatment for type 2 diabetes in 2017, however, it wasn’t until 2021 that the FDA gave it the green light to help those with obesity lose weight under the brand name Wegovy.2 Now, against the backdrop of the 2024 SELECT trial, the FDA has approved Wegovy for use to reduce cardiovascular complications.1
How semaglutide works
Semaglutide belongs to a class of medicines called glucagon-like peptide-1 (GLP-1) receptor agonists, which can either be taken on their own or in combination with other diabetes medicines to help manage blood sugar.2
It works by activating GLP-1 receptors found in your gut, pancreas, and brain. This activation triggers the body to release more insulin when blood sugar levels are high after eating. It also slows down how quickly the stomach empties, increases the growth of insulin-producing cells in your pancreas, and reduces the release of glucagon, which all help to decrease appetite.2
In the brain, specifically in the hypothalamus, semaglutide helps reduce feelings of hunger and cravings while making individuals feel fuller for longer. All these actions together help manage your blood sugar levels and support weight loss.2
Semaglutide is a long-lasting medication, much like extended-release versions of exenatide and dulaglutide. Its effectiveness over time is due to two key modifications: one helps it bind to albumin, which prolongs its stay in the body, and the other protects it from being broken down too quickly by an enzyme called DPP-4.2 This means it can work in your system for a longer period, giving you consistent benefits.
Helping the heart
Semaglutide has shown excellent results in managing type 2 diabetes and reducing heart disease risks. Through the SUSTAIN trials, we’ve learned that weekly injections of Ozempic® can significantly lower blood sugar levels compared to placebos and other diabetes medications.3,4 More importantly, these trials have shown that semaglutide can reduce the risk of major heart problems like heart attacks and strokes.3
Specifically, the SUSTAIN 6 trial found that semaglutide lowered the risk of heart-related death, nonfatal heart attacks, and nonfatal strokes by 26% compared to a placebo.4
Looking beyond diabetes and focusing on the detriments of obesity on those with CVD, the SELECT trial took place which looked at another form of semaglutide, Wegovy, on its effect on heart disease. The SELECT trial included 17,604 adults who were either obese or overweight and had a heart condition but no diabetes.1 The study found that those who took Wegovy had a 20% lower risk of major heart events, a 28% reduction in heart attacks, a 7% decrease in non-fatal strokes, and a 15% drop in heart-related deaths compared to those taking a placebo.1 Additionally, Wegovy users experienced a 19% lower death rate from any cause.1
What this means going forward
As a result of the post-World War II Baby Boom, the population aged 65 and older has grown significantly.5 Since four out of five heart disease deaths occur in this age group, this rise has led to a notable increase in the number of heart disease deaths.6
Ozempic is already available for lowering the risk of major heart events in patients with diabetes who also have cardiovascular disease and are either overweight or obese. The recent approval of Wegovy now formally allows doctors to expand treatment to a larger group: those with cardiovascular disease who are overweight or obese but do not have diabetes. Previously, some doctors prescribed Wegovy off-label for this purpose, but this new approval fast-tracks the heart care patients can receive.
This approval represents a significant step forward in heart disease management, especially as the population ages. With more treatment options available, we can better address the growing number of heart disease cases in older adults, ultimately helping to reduce heart-related deaths and improve the quality of life for many people.
As with all medicines, Wegovy should be used with caution. Just because it has been shown to reduce weight and manage CVD, doesn’t mean that the traditional advice of following a healthy diet and being more active should be thrown out of the window. Those who prescribe Wegovy must reinforce the necessity of adopting healthier behaviours alongside the medication not only to improve the effectiveness of treatment, but to encourage a mindset shift for individuals to follow eternally.
The numan take
Around 10-15 years ago, the idea of a medication that could significantly reduce weight loss and combat heart disease directly seemed far-reaching. Now, with this new approval, we have Wegovy. With obesity and heart disease being a great public health concern, this medicine holds promise in giving the ageing population a better chance for survival, while its use in weight management continues to change people’s lives.
References
Lincoff, A. M., Brown-Frandsen, K., Colhoun, H. M., Deanfield, J., Emerson, S. S., Esbjerg, S., … Ryan, D. H. (2023). Semaglutide and cardiovascular outcomes in obesity without diabetes. The New England Journal of Medicine, 389(24), 2221–2232. doi:10.1056/nejmoa2307563
Kommu, S., & Whitfield, P. (2024). Semaglutide. StatPearls Publishing.
Aroda, V. R., Ahmann, A., Cariou, B., Chow, F., Davies, M. J., Jódar, E., … Lingvay, I. (2019). Comparative efficacy, safety, and cardiovascular outcomes with once-weekly subcutaneous semaglutide in the treatment of type 2 diabetes: Insights from the SUSTAIN 1–7 trials. Diabetes & Metabolism, 45(5), 409–418. doi:10.1016/j.diabet.2018.12.001
Marso, S. P., Bain, S. C., Consoli, A., Eliaschewitz, F. G., Jódar, E., Leiter, L. A., … Vilsbøll, T. (2016). Semaglutide and cardiovascular outcomes in patients with type 2 diabetes. The New England Journal of Medicine, 375(19), 1834–1844. doi:10.1056/nejmoa1607141
Roger, V. L., Go, A. S., Lloyd-Jones, D. M., Adams, R. J., Berry, J. D., Brown, T. M., … Wylie-Rosett, J. (2011). Heart disease and stroke statistics—2011 update: A report from the American heart association. Circulation, 123(4). doi:10.1161/cir.0b013e3182009701
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