However, until recently, there was no medication that could directly address this risk factor and prevent serious heart problems in obese people.
That may change with the introduction of Wegovy, a new weight-loss drug that has shown promising results in a large clinical trial.
Wegovy is a weekly injection of semaglutide, a molecule that mimics a gut hormone called GLP-1.
This hormone helps regulate appetite and blood sugar levels and is often used to treat diabetes.
Wegovy is a higher dose of semaglutide than the one used for diabetes, and it was approved by the FDA in June 2023 as a treatment for obesity.
In August 2023, Novo Nordisk, the maker of Wegovy, announced the preliminary results of a landmark trial that involved more than 17,600 adults with heart disease and obesity, but not diabetes.
The trial, called SELECT, compared the effects of Wegovy versus placebo on the risk of cardiovascular events, such as heart attack, stroke, or death from heart disease.
The results were impressive:
after about three years of follow-up, Wegovy reduced the risk of cardiovascular events by 20% compared to the placebo.
This means that for every 100 people who took Wegovy, there were four fewer cardiovascular events than in the placebo group.
The benefit was consistent across different subgroups of age, sex, race, and baseline weight.
The trial also confirmed the weight-loss effects of Wegovy:
on average, people who took Wegovy lost 15% of their body weight, compared to 2.4% in the placebo group.
This translates to a difference of about 16 kilograms, or 35 pounds, for a person who weighs 100 kilograms, or 220 pounds, at the start of the trial.
The trial is the first to show that a weight-loss drug alone can have a significant impact on cardiovascular health in obese people.
Previous trials of other weight-loss drugs, such as orlistat and lorcaserin, did not show such benefits or had safety concerns that limited their use.
The trial is also the first to test a GLP-1 mimetic drug in people without diabetes and to show that it can lower the risk of heart disease independently of its effects on blood sugar.
The mechanism by which Wegovy protects the heart is not fully understood, but it may involve several factors. Besides reducing appetite and weight, Wegovy may also lower blood pressure, cholesterol, and inflammation, which are all linked to cardiovascular disease.
Wegovy may also improve the function of the blood vessels and the heart muscle, and prevent the formation of blood clots that can cause heart attacks and strokes.
The trial is not without limitations, however. The full details of the trial have not been published or peer-reviewed yet, and some important questions remain unanswered.
For example, what were the side effects of Wegovy, and how did they compare to the placebo?
How long did people need to take Wegovy to see the benefits, and what happened when they stopped?
How did Wegovy affect the quality of life and mental health of the participants?
And how did Wegovy compare to other interventions for weight loss and cardiovascular health, such as diet, exercise, or surgery?
These questions will hopefully be addressed in the future when the trial data is analyzed and presented in more depth.
Until then, Wegovy remains an exciting and promising option for people with obesity and heart disease, who may benefit from both its weight-loss and cardiovascular effects.
However, Wegovy is not a magic bullet, and it should be used as part of a comprehensive and individualized approach to obesity management, that includes lifestyle changes, behavioral support, and regular monitoring by a healthcare provider.
Summary:
Wegovy is a new weight-loss drug that can also lower the risk of heart attack, stroke, or death from heart disease by 20% in people with obesity and heart disease, but not diabetes.
This was shown in a large clinical trial called SELECT, which compared Wegovy to a placebo in more than 17,600 adults.
Wegovy works by mimicking a gut hormone that reduces appetite and blood sugar levels and may also have other beneficial effects on the heart and blood vessels.
The trial is the first to show that a weight-loss drug alone can have a significant impact on cardiovascular health in obese people.
However, the full details of the trial have not been published or peer-reviewed yet, and some important questions remain unanswered.
Wegovy should be used as part of a comprehensive and individualized approach to obesity management, that includes lifestyle changes, behavioral support, and regular monitoring by a health care provider.
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