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Semaglutide—the active ingredient in weight loss drugs like Ozempic and Wegovy—may benefit cardiovascular health and reduce the risk of heart attack in adults without diabetes, according to a 2023 SELECT study in the New England Journal of Medicine[1]Lincoff AM, Brown-Frandsen K, Colhoun HM, et al.. Semaglutide and Cardiovascular Outcomes in Obesity without Diabetes.. N Engl J Med. 2023;389(24):2221-2232.. . Presented at the 2024 European Congress of Obesity (ECO) on May 12-15, the study is putting the research back into focus.
Additionally, a new analysis based on the 2023 clinical trial—also presented at the conference—found that participants taking semaglutide sustained weight loss over four years during the trial[2]Ryan DH, Lingvay I, Deanfield J, et al.. Long-term weight loss effects of semaglutide in obesity without diabetes in the SELECT trial. . Nat Med. 2024.. . Both of these research papers potentially bolster the case for insurers to cover the costly medication for conditions other than diabetes or weight-related health concerns.
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Growing Research on Semaglutide for Cardiovascular Health
While the 2023 SELECT study stands out for its illustration of semaglutide’s cardiovascular benefit in individuals without diabetes, previous research indicates that semaglutide also reduces cardiovascular risks in people with diabetes. In fact, in 2020, the U.S. Food and Drug Administration (FDA) approved the use of Ozempic injections to reduce the risk of major adverse cardiovascular events (MACE) in adults with type 2 diabetes and known heart disease.
Widening the lens of research after 2020, the SELECT study enrolled 17,604 adults with pre-existing cardiovascular disease and overweight or obesity—but not diabetes.
Participants who took semaglutide for more than three years had a 20% lower risk of heart attack, stroke or death due to cardiovascular disease, regardless of their starting weight or the amount of weight that they had lost, according to the study. The finding suggests that those with mild obesity or who aren’t losing weight may still experience cardiovascular benefits.
“Our findings show that the magnitude of this treatment effect with semaglutide is independent of the amount of weight lost, suggesting that the drug has other actions which lower cardiovascular risk beyond reducing unhealthy body fat,” says John Deanfield, a University College London professor and the lead author on the study, in a press release.
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How Does Semaglutide Improve Cardiovascular Health?
Semaglutide may help improve cardiovascular health because of its impact on weight. The SELECT results indicate a significant reduction in participants’ waist circumference (WC), waist-to-hip ratio and weight—all of which can potentially improve cardiovascular health, says Sam Setareh, M.D., a cardiologist at Beverly Hills Cardiovascular and a Forbes Health Advisory Board member.
“WC not only forecasts mortality but also shows a positive correlation with cardiovascular risk, primarily due to visceral adipose tissue (VAT) of the abdomen,” says Dr. Setareh. VAT is a primary area where fat accumulates in the abdomen, impacting an individual’s WC.
“Both the WC-to-height ratio and the waist-to-hip ratio have been recognized as predictors of cardiovascular disease (CVD) and mortality,” continues Dr. Setareh, who adds that obesity is also associated with elevated blood pressure, dyslipidemia and hyperglycemia.
“Given the increasing prevalence of obesity and the prominence of cardiovascular disease as a global cause of mortality, initiating GLP-1 agonists [such as Ozempic] early in individuals with obesity or overweight, particularly those presenting with at least one comorbidity, could be advantageous,” explains Dr. Setareh.
Despite its potential benefits, the cost of semaglutide weight loss drugs like Ozempic acts as a barrier to entry for many individuals, with a 28-day supply costing upwards of $1,000.
Does Insurance Cover Semaglutide?
Commercial insurance coverage for semaglutide products vary by state, plan and provider, says Dr. Setareh. Most insurance companies only cover these medications as a type 2 diabetes treatment, since that was a primary use case approved by the FDA.
In March, thanks to the momentum from SELECT’s study, the FDA approved a new indication for Wegovy to reduce the risk of cardiovascular death, heart attack and stroke in adults with cardiovascular disease and either obesity or overweight.
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Sources
Footnotes
- Lincoff AM, Brown-Frandsen K, Colhoun HM, et al.. Semaglutide and Cardiovascular Outcomes in Obesity without Diabetes.. N Engl J Med. 2023;389(24):2221-2232..
- Ryan DH, Lingvay I, Deanfield J, et al.. Long-term weight loss effects of semaglutide in obesity without diabetes in the SELECT trial.. Nat Med. 2024..
References
- Compound Summary for Semaglutide. National Center for Biotechnology Information. Accessed 5/14/2024..
- Sattar N, Lee MMY, Kristensen SL, et al.. Cardiovascular, mortality, and kidney outcomes with GLP-1 receptor agonists in patients with type 2 diabetes: a systematic review and meta-analysis of randomised trials.. Lancet Diabetes Endocrinol. 2021;9(10):653-662..
- FDA approves Ozempic® for cardiovascular risk reduction in adults with type 2 diabetes and known heart disease, updates Rybelsus® label. Novo Nordisk. Accessed 5/14/2024.. Novo Nordisk. Accessed 5/14/2024..
- Semaglutide can produce clinically meaningful weight loss and reduce waist size for at least 4 years in adults with overweight or obesity who don’t have diabetes, and delivers cardiovascular benefits irrespective of weight lost.. European Association for the Study of Obesity. Accessed 5/14/2024..
- Jayedi A, Soltani S, Zargar MS, Khan TA, Shab-Bidar S.. Central fatness and risk of all cause mortality: systematic review and dose-response meta-analysis of 72 prospective cohort studies.. BMJ. 2020;370:m3324..
- Cao Q, Yu S, Xiong W, et al.. Waist-hip ratio as a predictor of myocardial infarction risk: A systematic review and meta-analysis.. Medicine (Baltimore). 2018;97(30):e11639..
- Health Risks of Overweight & Obesity.. National Institute of Diabetes and Digestive and Kidney Diseases. Accessed 5/15/2024..
- Feingold KR.. Obesity and Dyslipidemia. Endotext. 2023..
- Zalejska-Fiolka J, Birková A, Hubková B, et al.. Successful correction of hyperglycemia is critical for weight loss and a decrease in cardiovascular risk in obese patients.. J Nutr Biochem. 2022;106:109021..
- Medications Containing Semaglutide Marketed for Type 2 Diabetes or Weight Loss.. U.S. Food and Drug Administration. Accessed 5/15/2024..
- FDA Approves First Treatment to Reduce Risk of Serious Heart Problems Specifically in Adults with Obesity or Overweight.. U.S. Food and Drug Administration. Accessed 5/15/2024..
- A New Use for Wegovy Opens the Door to Medicare Coverage for Millions of People with Obesity.. KFF. Accessed 5/15/2024..
