Doctors in a large audience at the recent American Heart Association congress broke into spontaneous applause. A. Michael Lincoff, a cardiologist at Cleveland Clinic, has just revealed the startling and occasionally puzzling findings of a brand-new clinical experiment involving the weight loss medication semaglutide.
Lincoff announced on November 11 that the weight loss medication, marketed under the brand name Wegovy, reduced patients’ risk of serious cardiovascular issues by 20 percent. Additionally, during the course of the study’s 40 months or so, on average, it decreased the patients’ probability of dying, regardless of the cause.
Thanks to Lincoff’s findings, semaglutide—which is now used by doctors to treat obesity and diabetes—has yet another function. An advantage for the cardiovascular system has already been found in type 2 diabetics by earlier research. This new study is the first to demonstrate that semaglutide can benefit the hearts of non-diabetic individuals as well. It focused on overweight or obese patients with cardiovascular disease.
This broadens the pool of potential patients for whom the weight loss medication may be beneficial, according to Tiffany Powell-Wiley, an epidemiologist and cardiologist at the National Heart, Lung, and Blood Institute in Bethesda, Maryland. More than 6 million obese or overweight adults in the US alone suffer from cardiovascular disease but do not have diabetes. Powell-Wiley, who was not involved in the latest experiment, believes that semaglutide could be a game changer for these individuals. Nevertheless, she acknowledged the study’s shortcomings as well as the drug’s limitations, along with other attendees.
Powell-Wiley notes that, despite our desire for a fast cure to the global obesity epidemic, “it’s important to understand that this isn’t the panacea.” She claims that the effectiveness of semaglutide in a varied population is still unknown. Furthermore, the weight loss medication doesn’t address the socioeconomic, environmental, or sociological issues that cause obesity in the first place, let alone its possible negative effects on health.
Semaglutide decreased the chance of mortality, stroke, and heart attack.
Semaglutide is one medication in a growing family of medications used to treat obesity. A new one, called Zepbound, was approved by the US Food and Drug Administration on November 8. It is a cousin of semaglutide and is marketed as tirzepatide.
In 2017, semaglutide—marketed under the trade name Ozempic—was initially made available for the treatment of diabetes. The medication’s array of applications has only expanded since then. The FDA gave it the go-ahead in 2020 to reduce cardiovascular risk in patients with heart disease and diabetes. And 2021 saw the addition of obesity treatment (using Wegovy at a higher dose) to the list.
More than 17,000 participants took part in Lincoff’s semaglutide experiment, known as SELECT; half of them received weekly injections of semaglutide for about three years, while the other half received a placebo. Eight percent of the placebo group had experienced a nonfatal stroke or heart attack, or had passed away from cardiovascular reasons by the time the experiment ended. Lincoff reported at the meeting and online in the New England Journal of Medicine on November 11 that the semaglutide group saw a decrease in that percentage to 6.5 percent.
Although the difference between the two groups might not seem like much, Amit Khera, a cardiologist at Dallas’ UT Southwestern Medical Centre who was not involved in the experiment, says, “it’s a massive result.” He says that the significance of discovering a novel medication for individuals suffering from cardiovascular ailments cannot be overstated.
At a press conference on November 10, Lincoff stated that the condition is “the largest source of mortality in the world” and that no one treatment can completely eradicate it. Instead, medical professionals attempt to gradually improve it with a range of therapies.
According to Khera, semaglutide is an additional tool in the toolbox of cardiologists treating patients with heart disease who are overweight or obese.
Still unknown are the drug’s mechanisms of action and target audience.
The trial’s initial news, as reported by trial sponsor Novo Nordisk in August (SN: 8/29/23), was expanded upon by the current study results. Doctors at the time were interested in learning who the weight loss medication treated, how it worked, and what adverse effects it caused. The most recent study raises certain issues and leaves others completely unanswered.
Those using semaglutide had a somewhat higher trial dropout rate than those taking a placebo. The gastrointestinal adverse effects of the medication, which include nausea, diarrhoea, and vomiting, appeared to be the main cause of that variation. In the semaglutide group, there were a few less significant problems such as infection or malignancy.
Despite the patients’ obvious cardiovascular improvements from semaglutide, researchers were drawn to one enigmatic feature of the data. The preventive effects of the weight loss medication were observed early in the experiment, even before the participants had significant weight loss.
That’s significant because it implies semaglutide may be directly improving heart health, possibly in addition to the usual advantages of weight loss, according to Caroline Apovian, an expert in obesity medicine at Brigham and Women’s Hospital in Boston and Harvard Medical School. She serves on the scientific advisory board for Novo Nordisk but was not involved in the study. According to Lincoff, his staff is “working feverishly” to analyse the SELECT data in order to comprehend semaglutide’s effects better.
Thousands of trial participants’ demographic and medical data are included in such files. However, Powell-Wiley notes that there is one “huge limitation” to the trial: Of the participants in the study, 72% were men and 84% were White.
She stated that it is imperative to increase the diversity of individuals included in clinical trials such as these. She raised this issue at a panel discussion that followed Lincoff’s speech, and like the trial’s outcomes, it was warmly received. According to Powell-Wiley, obesity disproportionately affects African Americans, Hispanics, and Native Americans in the United
States, and the results of the recent research provide little insight into the effects of semaglutide on these populations.