Wegovy has heart health 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 while taking the drug or don't have severe illness. obesity Let's start with what the study showed.

Earlier results from the same study, called SELECT, showed that Wegovy, a GLP-1 weight loss drug, can have this effectbut it is unclear whether the heart health benefits were due to weight loss alone. Pig study the implication was that such drugs directly protected the heart, which has now been demonstrated in humans.

“The idea is that the benefits of these drugs for your heart and arteries are independent of your weight loss, which reframes these drugs as disease-modifying drugs regardless of weight gain,” says John Deanfield at University College London.

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

The SELECT trial compared semaglutide and placebo for cardiovascular risks in 17,604 people aged 45 years and older who were overweight or obese. No one had diabetes, but everyone had some form heart disease. In November 2023, Deanfield and colleagues reported that semaglutide reduced the risk of heart attack, stroke, or other serious heart attack by 20 percent.

I wonder if this was due to weight loss The researchers have now scrutinized their data across different body mass indexes (BMIs) and weight loss categories. They found people with a starting BMI of 27 – considered mildly obese in some cases, had the same improvement in cardiovascular risk after taking semaglutide as people with the highest BMI of 44 and severe obesity.

The team also realized that weight loss—whether in the first 20 weeks or over the roughly two-year study period—had little impact on cardiovascular benefits.

But abdominal fat did appear to play an important role. The team found that a smaller waistline at the start of the study was associated with a lower risk of cardiovascular problems, regardless of whether someone was in the semaglutide or placebo group. But over a couple of years of taking semaglutide, each 5-centimeter decrease in waist circumference was associated with a roughly 9 percent reduction in the risk of cardiovascular events. The team estimated that waist size reduction accounts for about a third of the drug's heart-protecting benefit; its other consequences were less obvious.

The results support semaglutide's potential beyond simple weight loss: People in the placebo group even experienced a slightly increased risk of heart problems if they lost weight. This may be because this weight loss reflects the underlying cause health problems, says Deanfield.

Further research is needed to understand how semaglutide and possibly other GLP-1 drugshave such effects. Deanfield postulates that this may be due to improvements in blood vessel lining and blood pressure, but an anti-inflammatory effect is also possible.

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

The benefits may also be related to the way semaglutide acts on the fatty tissue around the heart, known as epicardial adipose tissue, the scientists said. Gianluca Iacobelli at the University of Miami in Florida. “Semaglutide targets receptors in epicardial adipose tissue, improves the tissue, and then improves cardiac function, which ultimately reduces the risk of cardiovascular events,” he says.

“The question is, what parameters should we use to identify people who might benefit most from these drugs?” speaks Stefano Masi at the University of Pisa, Italy. “I think this is going to be a problem of the future.”