Semaglutide has heart benefits regardless of weight loss, research finds
Semaglutide appears to be protective against heart attacks and other cardiac events regardless of weight loss, research has shown.
The results could have ‘profound’ implications for how the drug is used, experts have said.
It follows previous evidence that semaglutide is associated with a 20% reduction in major cardiovascular events in patients with overweight or obesity but not diabetes.
In the latest analysis, researchers looked at the relationship between the reduction in cardiovascular risk and baseline weight as well as weight loss while taking the drug in data from the SELECT trial.
Reporting the findings in The Lancet, they found that semaglutide significantly reduced the incidence of major cardiovascular events compared with placebo among the 17,604 studied.
And they found consistent benefits across all baseline weight and waist circumference categories.
It meant that those with a BMI of 27, saw similar benefits as those with obesity who had the highest BMIs.
The benefits were also largely independent of how much weight people lost in the first four and a half months of taking the drug, they added.
There was however a link between the reduction in waist circumference and fewer cardiovascular events, which accounted for a third of the drug’s protective effect on the heart after two years, they added.
Study lead Professor John Deanfield from the University College London Institute of Cardiovascular Science said: ‘Abdominal fat is more dangerous for our cardiovascular health than overall weight and therefore it is not surprising to see a link between reduction in waist size and cardiovascular benefit.
‘However, this still leaves two thirds of the heart benefits of semaglutide unexplained. These findings reframe what we think this medication is doing.
‘It is labelled as a weight-loss jab but its benefits for the heart are not directly related to the amount of weight lost. In fact it is a drug that directly affects heart disease and other diseases of ageing.’
He added: ‘This work has implications for how semaglutide is used in clinical practice. You don’t have to lose a lot of weight and you don’t need a high BMI to gain cardiovascular benefit. If your aim is to reduce cardiovascular disease, restricting its use to a limited time only and for those with the highest BMIs doesn’t make sense.’
But he said the benefits need to be weighed against potential side effects.
Professor Azeem Majeed, professor of primary care and public health at Imperial College London, said: ‘This finding challenges the belief that weight loss is the primary driver of benefit, showing instead that waist circumference reductions mediate only about a third of the effect on major adverse cardiovascular events.
‘The findings reinforce the use of semaglutide as a disease-modifying therapy for high-risk patients and not just as a weight-loss tool.
‘In future, this may potentially lead to broadening the use of semaglutide beyond strict BMI cutoffs and encouraging its earlier use in cardiovascular disease prevention.’
Professor Tim Chico, professor of cardiovascular medicine at the University of Sheffield, said: ‘The implications of this and other similar studies are profound.
‘The average man or woman in the UK has a BMI over 27, so most people with heart disease are likely to benefit from adding semaglutide to their existing drugs, which already usually include aspirin, statins, blood pressure lowering drugs, and other blood thinners.
‘Evidence from this and other studies suggests we should consider giving these drugs to the very large number of people likely to get a meaningful benefit.’
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