First weight loss drug approved for heart disease treatment.Here’s what we know

Written by Sarah Reardon

The drug semaglutide, sold as Ozempic or Wegovy, is well known for helping you lose a lot of weight quickly. The U.S. Food and Drug Administration has approved Wigovy, a version of semaglutide currently prescribed for weight loss, to prevent serious cardiovascular disease in certain high-risk people.

The FDA’s March 8 announcement allows doctors to recommend a higher maximum dose of semaglutide than Ozempic for people who are overweight or obese and have had at least one cardiovascular event, such as a heart attack or stroke. Novo Nordisk’s Wigoby can be prescribed for many patients. “This opens up a whole new group of patients,” said Nicholas Marston, a cardiologist at Brigham and Women’s Hospital.

Here’s what we know about semaglutide’s effects on cardiovascular disease and how it works.

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Who is a good candidate to take the drug to reduce heart risk?

The FDA’s approval expands the use of semaglutide to people with a BMI of 27 or higher (qualified as overweight or obese) with a history of cardiac events. However, it is unclear whether this drug is equally effective in preventing cardiovascular disease in people with a low body mass index. And there are no tests yet for people who may be at risk for cardiovascular disease but have not been diagnosed.

How effective is semaglutide in preventing cardiovascular disease?

The FDA based its decision on a 2023 study called Semaglutide Effects on Cardiovascular Disease in Overweight or Obese People (SELECT), in which Novo Nordisk tested Wegovy in more than 17,000 people. All participants had a body mass index (BMI) of 27 or higher. However, unlike previous semaglutide trials, the SELECT participants had no history of diabetes. It was first approved as a treatment for diabetes in 2017.

The trial showed that people who took semaglutide lost, on average, nearly 10 percent less weight than those who took a placebo. They had a 20 percent lower risk of heart attack and stroke over about three years, and significantly lowered their cholesterol and blood pressure.

Given these study results, published in November, the FDA’s decision to approve a drug to prevent heart disease was “not at all surprising,” says Joseph Wu, a cardiologist at Stanford University. He says his 20% reduction in risk is impressive. By comparison, a 2023 trial of bempedoic acid, another new heart drug, found that it reduced the risk of heart attack and stroke by 13 percent over three years. Wegovy may join the ranks of other effective cardiovascular drugs such as beta-blockers and statins.

How does this drug prevent heart problems?

Semaglutide is generally thought to reduce weight by binding to molecules on the surface of cells called GLP-1 receptors, where it mimics hunger hormones and slows the rate at which the stomach empties. This reduces your appetite and eats less, resulting in rapid weight loss.

However, its effects on the cardiovascular system are less clear. “That’s the million-dollar question,” Wu said. Weight loss probably accounts for much of the effect, he says. Researchers have already shown that for overweight people, losing 10% of their body weight significantly reduces their risk of cardiovascular disease and stroke, and has other benefits such as reducing knee pain and shortness of breath. I know.

It’s also possible that semaglutide has other effects, Wu and Marston say. This drug binds directly to GLP-1 receptors or other targets on the heart and blood vessels, affecting their function and reducing inflammation that can damage the cardiovascular system. There is likely to be. The SELECT trial found evidence that the drug lowers blood pressure, inflammation (measured by blood proteins made by the liver), and cholesterol.

Marston said determining how much of that effect is due to weight loss or additional effects is likely to be a priority for future research. “We always want to understand why something works.” Scientists use human cells or animal models to better understand semaglutide’s mechanism of preventing cardiovascular disease Now we will be able to test some of these questions in the laboratory. The SELECT trial also enabled Nordisk to collect this data set to gain further information about the drug’s effectiveness.

What are the side effects?

Semaglutide is not a new drug and its side effects and risks are well known. The most common are gastrointestinal problems such as nausea and constipation, which occur because the drug slows gastric emptying.

However, researchers have not yet studied what happens to cardiovascular risk when people stop taking the drug. People who take semaglutide to lose weight but stop it are likely to be at higher cardiovascular risk than before because they usually gain the weight back quickly, Wu said. “The main message is that taking this drug does not eliminate the need to lead a healthy lifestyle,” he says.

What do scientists still not know about semaglutide and heart disease?

Wu says it’s still unclear whether losing 10 percent of body weight without weight-loss drugs has a different impact on cardiovascular risk than losing weight with semaglutide. No one has ever made a direct comparison. And he added that the SELECT trial did not include many participants of different races or genders. Over 70% were male and 84% were white. As more people start taking the drug for weight loss, researchers may be able to collect more data to determine how effective the drug is in a broader population. .