Wegovy has heart-healthy benefits even if weight loss is minimal

The weight-loss drug Wegovy reduces the risk of heart attacks and other cardiovascular problems, even among people who don’t lose much weight when taking the drug or aren’t obese to begin with, a study shows.

Previous results from the same trial, called SELECT, suggested that Wegovy — a GLP-1 weight-loss drug — might have this effect, but it wasn’t clear whether the heart health benefits were due to weight loss alone. A study in pigs indicated that these drugs directly protect the heart, which has now been proven in humans.

“The take-home message is that the cardiovascular benefit of these drugs is not dependent on weight loss, which recasts these drugs as disease-modifying drugs independent of weight benefit,” he says. John Denfeld At University College London.

Wegovy, along with the type 2 diabetes drug Ozempic, contains the GLP-1 drug semaglutide. Although approved for weight loss and diabetes, these treatments have shown potential in treating a range of conditions, such as dementia and alcoholism.

The SELECT trial compared semaglutide with placebo for cardiovascular risk in 17,604 people, aged 45 years and older, who were overweight or obese. None of them had diabetes, but they all had some form of heart disease. In November 2023, Denfeld and colleagues reported that semaglutide reduced the risk of having a heart attack, stroke, or other major cardiac event by 20 percent.

The researchers wondered if this was due to weight loss alone, so they now examined their data across different categories of body mass index (BMI) and weight loss. They found people with a BMI starting at 27 – It is considered mild obesity In some cases – they got similar improvements in heart disease risk after taking semaglutide as those with the highest BMI, which was 44, and severe obesity.

The team also realized that the amount of weight lost—either in the first 20 weeks or over the approximate two-year duration of the trial—had little impact on cardiovascular benefits.

But belly fat seems to play an important role. The team found that a smaller waist at the start of the study was associated with a lower risk of cardiovascular problems, regardless of whether a person was in the semaglutide or placebo group. But over two years when taking semaglutide, every 5-centimeter reduction in waist circumference was associated with a 9 percent lower risk of cardiovascular disease. The team calculated that a reduction in waist circumference represents approximately one-third of the drug’s heart-protecting benefit. The rest of its effects were less clear.

The results support semaglutide’s potential beyond just weight loss, with people in the placebo group experiencing a slightly increased risk of heart problems if they lost weight. This may be because this weight loss reflects underlying health issues, Denfeld says.

More research is needed to find out how semaglutide, and perhaps other GLP-1 drugs, affect these effects. Denfeld hypothesizes that it may have a role in improving the lining of blood vessels and blood pressure, but there may also be an anti-inflammatory effect.

“Inflammation turns out to be a very important mechanism for multiple diseases that we would all like to avoid,” he says. “This appears to be a common pathway that these drugs target.”

The benefits could also be related to how semaglutide acts on the fatty tissue around the heart, known as epicardial adipose tissue, he says. Gianluca Ecobellis At the University of Miami in Florida. “Semaglutide targets epicardial adipose tissue receptors, optimizes the tissue, and then improves heart function to ultimately reduce the risk of cardiovascular disease,” he says.

“The question is: What criteria should we use to determine who can get the greatest benefits from taking these medications?” He says Stefano Massi At the University of Pisa, Italy. “I think this will be the challenge for the future.”

Topics:

• Medical medications /
• My heart disease