The weight loss drug semaglutide may offer cardiovascular benefits for people with overweight and obesity that is independent of weight loss, according to researchers from University College London (UCL).
The study’s preliminary findings, presented at the recent European Congress on Obesity (ECO), suggest that semaglutide may have beneficial effects on heart disease, even for individuals who do not experience weight loss, and are not linked to starting weight.
The research suggested that even people with mild obesity or those not losing weight are likely to gain some cardiovascular advantage and could have implications for current NICE guidelines, which advise clinicians to stop semaglutide treatment in patients who lose less than five per cent of their weight after six months.
Semaglutide mimics the action of the glucagon-like peptide-1 (GLP-1) hormone, lowering blood sugar levels and helping people feel full after a meal. It is primarily prescribed to adults with type 2 diabetes but is also approved for weight loss in people with obesity or overweight who have at least one other health issue.
In 2023, the same research group showed that adults who took semaglutide for three years who were obese or overweight but who did not have diabetes had a 20 per cent lower risk of heart attack, stroke, or death due to cardiovascular disease and, on average participants in the trial also lost nearly 10 per cent of their body weight.
For this study, the researchers examined the effects of taking semaglutide on adults with overweight or obesity who had previously experienced cardiovascular disease such as heart attack, stroke and peripheral artery disease. Over 17,000 adults from 41 countries were recruited between 2108 and 2023 and treated with semaglutide (2.4mg) or a placebo for an average of 40 months. The researchers examined the relationship between weight at the beginning of the study, weight changes during the research and cardiovascular health, such as the time to the first major adverse cardiovascular event and other heart failure measures.
The study found that semaglutide has significant benefits for people with pre-existing cardiovascular problems. The researchers found the proportional reduction in major adverse cardiovascular events was similar across the range of BMIs studied and was not dependent on weight loss.
Professor John Deanfield from the UCL Institute of Cardiovascular Disease, who led the new research, said: ‘These findings have important clinical implications. Around half of the patients I see in my cardiovascular practice have levels of weight equivalent to those in the SELECT trial and are likely to benefit from taking semaglutide on top of their usual level of guideline-directed care.’
He added: ‘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.’
The researchers are unsure why semaglutide might reduce cardiac mortality but suggest that the medication may positively impact blood sugar, blood pressure, or inflammation. Alternatively, they suggest it could directly affect the heart muscle and blood vessels or combine one or more factors. Despite the findings, the authors caution that this was not a ‘primary prevention trial’ and further research is needed.
In a separate SELECT data study, also presented at ECO and published in Nature Medicine, the same research group found that semaglutide achieved clinically meaningful weight loss over at least four years in men and women of all races, ages, and body sizes across all regions.
The lead author of that study, Professor Donna Ryan from Pennington Biomedical Research Center in New Orleans, said: ‘This degree of weight loss in such a large and diverse population suggests that it may be possible to impact the public health burden of multiple obesity-related illnesses. While our trial focused on cardiovascular events, many other chronic diseases, including several types of cancer, osteoarthritis, and anxiety and depression, would benefit from effective weight management.’
