The weight loss drug semaglutide also delivers heart health and cardiovascular benefits, irrespective of a patient’s starting weight or the amount of weight they lose, research has concluded.
Preliminary findings from a research team led by University College London suggest that even people with mild obesity or those not losing weight will be likely to gain some heart health and cardiovascular advantage from taking the drug. The findings were presented at this year’s European Congress on Obesity.
Led by Professor John Deanfield from the UCL Institute of Cardiovascular Disease, the study looked at data from the landmark Semaglutide and Cardiovascular Outcomes (SELECT) trial.
The SELECT trial is the largest and longest clinical trial of the effects of semaglutide, which is also known by the brand name Wegovy, on weight in more than 17,000 adults with overweight and obesity but not diabetes.
The analysis examined the relationship between weight measures at baseline, and change in weight during the study, with cardiovascular outcomes. These included the time to first major adverse heart health or cardiovascular event and heart failure measures.
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Professor Deanfield said: “These findings have important clinical implications. Around half of the patients that I see in my cardiovascular practice have levels of weight equivalent to those in the SELECT trial and are likely to derive benefit from taking semaglutide on top of their usual level of guideline directed care.
“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.
“These alternative mechanisms may include positive impacts on blood sugar, blood pressure, or inflammation, as well as direct effects on the heart muscle and blood vessels, or a combination of one or more of these.”
Semaglutide is a GLP-1 medication primarily prescribed for 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.
This class of medications simulates the functions of the body’s natural incretin hormones, which helps to lower blood sugar levels after a meal. Adjusting these hormone levels can also make people feel full, and in doing so, helps lower their daily calorie intake.
In 2023, the SELECT trial reported that adults with overweight or obesity but not diabetes taking semaglutide for more than three years had a 20% lower risk of heart attack, stroke, or death due to cardiovascular disease, and lost an average 9.4% of their bodyweight.
Between October 2018 and June 2023, 17,604 adults (aged 45 or older; 72% male) from 804 sites in 41 countries with overweight or obesity (BMI of 27 kg/m² or higher) were enrolled and treated with semaglutide (2.4mg) or placebo for an average of 40 months.
They had previously experienced a heart health issue, such as a heart attack, stroke and/or had peripheral artery disease, but did not have type 1 or type 2 diabetes when they joined the study.
The authors caution that SELECT is not a primary prevention trial, so that the data cannot be extrapolated to all adults with overweight and obesity to prevent major adverse cardiovascular events.
Despite being large and diverse, the study does not include enough individuals from different racial groups to understand different potential effects.
A separate study co-authored by Professor Deanfield, and published in the journal Nature Medicine, also looked at SELECT trial data. This 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, with a lower rate of serious adverse events compared with placebo.
The lead author of that study, Professor Donna Ryan from Pennington Biomedical Research Center in New Orleans, said: “Our long-term analysis of semaglutide establishes that clinically relevant weight loss can be sustained for up to four years in a geographically and racially diverse population of adults with overweight and obesity but not diabetes.
“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.”
Employers monitoring employees’ weight?
Separately, with obesity continuing to rise across the UK, the National Obesity Forum has controversially suggested employers could be adopting Japan’s ‘Metabo’ law. This is where employers in Japan measure employees to ensure that they are a ‘healthy’ weight.
The law was introduced in 2008, and requires employees aged 40-70 to be measured once a year. Employees whose weight is determined to be ‘too high’ are fined. The forum’s Tam Fry has now suggested the UK should consider taking this approach in a bid to increase the health of the country.
However, Andrew Willis, associate director of legal at law firm Croner, has cautioned employers to think very carefully before adopting this approach: “Employers that are seriously considering taking such an approach will have lots to think about. And it’s likely that any such approach would be met with strong resistance from employees.
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“Just because someone is slim or overweight, it doesn’t mean that they are any better or worse at their job. Top talent could be sacrificed if employers focus only on weight rather than ability. Being slim doesn’t correspond with being more productive at work or being a high achieving employee.
“There are also legal considerations given that weight could be linked to a disability for some employees, and case law has shown that obesity itself could be a disability,” he highlighted.
