A groundbreaking clinical trial on the weight loss drug semaglutide, marketed as Wegovy, has unveiled compelling results at the recent American Heart Association meeting. Cleveland Clinic cardiologist A. Michael Lincoff reported that weekly injections of Wegovy led to a 20 percent reduction in the risk of major cardiovascular problems, coupled with a decrease in overall mortality over the approximately 40-month study period.
This development adds another layer to semaglutide’s multifaceted applications, initially recognized for its efficacy in treating diabetes and obesity. Previous research had established cardiovascular benefits for individuals with type 2 diabetes. However, the latest study, focusing on overweight or obese patients with cardiovascular disease, marks the first evidence that semaglutide can be beneficial for individuals without diabetes.
Tiffany Powell-Wiley, a cardiologist and epidemiologist at the National Heart, Lung, and Blood Institute, notes the significance of this finding in expanding the potential beneficiary pool. In the United States alone, over 6 million individuals classified as obese or overweight suffer from cardiovascular disease without diabetes. Powell-Wiley underscores that while Wegovy could be transformative for this demographic, it is not a cure-all. She emphasizes the importance of recognizing the drug’s limitations and its inability to address the societal, environmental, and social factors contributing to obesity and associated health consequences.
The semaglutide trial, known as SELECT, encompassed more than 17,000 participants, half of whom received weekly semaglutide injections for approximately three years, while the other half received a placebo. Lincoff presented the findings at the meeting and published them online in the New England Journal of Medicine. The results indicated that the semaglutide group experienced a reduction in the incidence of nonfatal strokes, heart attacks, or death due to cardiovascular causes, dropping from 8 percent in the placebo group to 6.5 percent in the semaglutide group.
While this percentage difference may appear modest, cardiologist Amit Khera from UT Southwestern Medical Center in Dallas emphasizes its magnitude in addressing cardiovascular disease, the leading global cause of mortality. Lincoff echoed this sentiment at a news conference, highlighting the absence of a singular therapy capable of eradicating the disease and the incremental benefits offered by various treatments.
The study results build upon earlier reports from August, shedding light on the drug’s efficacy, side effects, and participant dropout rates. Notably, participants on semaglutide were more likely to discontinue the trial due to gastrointestinal side effects, including nausea, diarrhea, and vomiting. However, serious issues such as cancer or infection were slightly less frequent in the semaglutide group.
An intriguing aspect of the data is the early manifestation of semaglutide’s protective effects, occurring before significant weight loss among participants. This raises questions about whether the drug directly enhances heart health, potentially beyond the benefits associated with weight loss. Caroline Apovian, an obesity medicine specialist at Harvard Medical School, acknowledges this mystery and underscores ongoing efforts to analyze SELECT data for a more comprehensive understanding of semaglutide’s actions.
Despite the promising results, Powell-Wiley draws attention to a notable limitation in the trial’s participant demographics. She points out that 84 percent of the study participants were white, and 72 percent were men. In light of the disproportionate impact of obesity on African-American, Hispanic, and Indigenous populations in the United States, Powell-Wiley emphasizes the critical need for more diverse representation in clinical trials to better understand how semaglutide functions in various demographic groups.
