Weight-loss drug Semaglutide could significantly reduce the risk of heart attacks

A new study, led by Professor John Deanfield from University College London (UCL), reveals that the anti-obesity medication semaglutide could significantly reduce the risk of heart attacks and other major cardiovascular events in people who are overweight and have pre-existing heart conditions. This includes individuals who suffer from heart failure, challenging earlier concerns about the drug's safety for this group.

The study, published in The Lancet, adds to growing evidence supporting semaglutide’s cardiovascular benefits. Earlier research from the same team found that weekly injections of the drug led to a 20% reduction in major adverse cardiac events (MACE) like heart attacks and strokes in people with obesity or overweight who also had cardiovascular disease. The new findings focus on a subgroup of individuals within this category who also had heart failure.

Heart failure occurs when the heart struggles to pump blood effectively around the body, leading to various health issues. Despite this added complication, the study found that semaglutide still provided significant benefits to patients with heart failure.

The data comes from the SELECT trial, a landmark study that tracked 17,605 participants over three years. Of this larger group, 4,286 participants were diagnosed with heart failure at the start of the trial. These individuals were randomly assigned to receive either semaglutide or a placebo, allowing researchers to compare the outcomes over time.

The results were striking. Those who received semaglutide saw a 28% reduction in the risk of experiencing a major cardiac event, with 9.1% of patients in the semaglutide group experiencing an event compared to 12.3% in the placebo group. Additionally, there was a 24% reduction in deaths related to cardiovascular disease among those with heart failure and a 19% decrease in overall mortality.

Professor Deanfield highlighted the importance of these findings, stating, "Our previous SELECT analysis showed the benefits of semaglutide for people with cardiovascular disease who had obesity or were overweight. This new study finds that, within this group, people with heart failure did just as well as people without in terms of the outcomes we measured."

This challenges earlier fears that semaglutide could be harmful to people with a specific form of heart failure, known as reduced ejection fraction, where the heart pumps less blood than normal. Instead, the study found that semaglutide’s benefits were consistent across different types of heart failure.

Semaglutide is part of a class of medications known as GLP-1 receptor agonists. These drugs mimic the effects of natural incretin hormones in the body, which help regulate blood sugar levels after eating. Originally developed to treat type 2 diabetes, semaglutide is the active ingredient in the drugs Wegovy and Ozempic, both of which have garnered attention for their weight loss benefits.

The SELECT trial has had a significant impact on how semaglutide is viewed by regulatory bodies. In July, the UK’s medicines regulator approved Wegovy as a treatment for individuals with cardiovascular disease based on the trial’s results. However, it is not yet available for this purpose on the NHS, where the drug is only prescribed for weight management and for those with type 2 diabetes.

To be considered for broader use, semaglutide's cardiovascular benefits may need to be compared to those of other drugs like SGLT2 inhibitors, which are also known to have heart-protective effects.

Although the exact mechanisms by which semaglutide benefits the heart are not fully understood, researchers suggest that it could be related to its effects on blood sugar, blood pressure, inflammation, and possibly direct actions on the heart and blood vessels. The study also reported a reduction in all-cause mortality among patients, suggesting that the drug may offer additional, as yet unknown, advantages.

The SELECT trial's large scale provided an opportunity to examine the drug's effects on different types of heart failure, namely preserved ejection fraction and reduced ejection fraction. These two forms of heart failure are caused by different factors and respond to treatments in varying ways.

Traditional therapies often struggle to improve outcomes for patients with preserved ejection fraction, which makes semaglutide's consistent effectiveness across both types notable. The drug’s benefits were also found to be independent of age, sex, and baseline body mass index (BMI), indicating broad applicability.

Not all outcomes were positive, however. Gastrointestinal disorders led to a higher rate of treatment discontinuation in the semaglutide group compared to the placebo group. This side effect was more prevalent among patients with heart failure, affecting 14.7% of the semaglutide group compared to 9.0% in the placebo group. Even among those without heart failure, gastrointestinal issues led to more treatment discontinuations in the semaglutide group (17.2% vs. 7.9%).

Despite these side effects, the researchers believe that semaglutide has the potential to reduce the risk of major cardiac events in a broad range of patients with cardiovascular disease. However, they also note that further studies are needed to assess its impact specifically on heart failure outcomes. Since SELECT was not designed solely as a heart failure trial, the researchers caution against generalizing these findings to all heart failure patients.

The study did have some limitations. Most of the participants were male, and there was a high proportion of white individuals. To ensure that these findings apply to a broader population, the researchers recommend that future GLP-1 receptor agonist trials examine the effects of the drug across different ethnicities and genders.

Semaglutide has been extensively studied for a range of health benefits beyond weight loss. Here are some scientifically studied benefits:

These benefits make Semaglutide a versatile medication with potential applications beyond its initial approval for diabetes management and weight loss.

Always consult your doctor or other qualified healthcare provider with any questions you may have regarding a medical condition, procedure, or treatment, whether it is a prescription medication, over-the-counter drug, vitamin, supplement, or herbal alternative.

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