Published on November 14, 2023, 12:45 am
Results from a groundbreaking clinical trial conducted this summer have revealed that a weight-loss medication could potentially reduce the risk of heart attack, stroke, and heart-related death in individuals with cardiovascular disease. The study focused on Novo Nordisk’s Wegovy, which belongs to the GLP-1 receptor agonists class of drugs. These medications have generated considerable excitement among physicians due to their potential benefits.
During the trial, it was found that Wegovy reduced the risk of another cardiovascular event by 20%. These results were presented at the American Heart Association conference in Philadelphia, confirming the initial findings. Dr. Ania Jastreboff, director of the Yale Obesity Research Center and one of the trial’s conductors, expressed enthusiasm about the prospect of treating not only obesity but also other related diseases like hypertension, high cholesterol, and type 2 diabetes. She stated that treating obesity has clear health benefits.
One question remains unanswered: whether Wegovy’s heart benefits are solely attributed to weight loss or if the medication has additional effects. This aspect requires further investigation. Nevertheless, experts agree that we are currently entering a new era in treating obesity and its associated risks.
The recent approval by the US Food and Drug Administration of Eli Lilly’s Zepbound for obesity represents yet another addition to the treatment options available. Zepbound will directly compete with Wegovy and both drugs use similar active compounds. Wegovy’s sister drug is Ozempic while Zepbound uses tirzepatide. They are all administered as a once-weekly self-administered shot.
GLP-1 receptor agonists simulate hormones that stimulate insulin production, induce feelings of fullness, and reduce appetite. While semaglutide targets GLP-1 alone, tirzepatide targets both GLP-1 and another hormone called GIP.
The trial demonstrated various positive outcomes for those using Wegovy over a two-year period: participants were less likely to develop diabetes or have blood sugar levels considered “prediabetes,” lost 9.4% of their body weight compared to 0.9% in the placebo group, and experienced reductions in waist circumference, systolic blood pressure, C-reactive protein (a marker of inflammation), and triglycerides.
Cardiologist Dr. Steven Nissen from the Cleveland Clinic believes these effects further highlight the benefits of weight loss. He emphasized that weight loss can bring about significant changes and expressed optimism about tirzepatide potentially leading to even stronger cardiovascular benefits due to its greater levels of weight loss demonstrated in clinical trials.
The Wegovy trial enrollment consisted of 17,604 people with a body mass index above 27 who had cardiovascular disease or symptoms indicating peripheral artery disease. Notably, participants did not have a history of diabetes, as a previous trial had already shown reduced cardiovascular risk in diabetic individuals using GLP-1 drugs like Ozempic.
Throughout the study, only 6.5% of the group taking Wegovy experienced a heart attack, stroke, or death from heart-related causes compared to 8% in the placebo group. This translates into the reported 20% benefit. These results are particularly remarkable considering that approximately 90% of trial participants were already taking statins and other standard heart care medications.
Dr. A Michael Lincoff from the Cleveland Clinic, who led this trial, highlighted that differences between treatment groups emerged early on after initiating treatment – within the first few months. The study revealed a notable risk reduction across three measures: deaths from cardiovascular causes (15%), heart attacks (28%), and strokes (7%). Detailed statistical significance for these individual measures was not explicitly provided; however, an overall risk reduction of 20% holds strong statistical value.
Safety concerns arising from Wegovy’s use did not emerge during the trial; however, more individuals discontinued using semaglutide due to adverse events compared to the placebo group. The most common side effects were gastrointestinal disorders such as nausea, vomiting, and diarrhea. Additionally, there was a slight increase in gallbladder-related disorders among those using Wegovy.
It is worth noting that the weight loss observed in this trial (9.4%) was slightly lower than seen in previous studies involving Wegovy, where average weight loss was closer to 15%. This trial did not focus explicitly on weight management like other trials often do; thus, it aimed to replicate how cardiovascular disease is treated in real-world scenarios. In this study, participants also received varying doses of Wegovy based on their tolerance for side effects.
Dr. Lincoff emphasized that heart benefits became evident earlier in the study than significant differences between Wegovy and placebo groups regarding weight loss. He also highlighted that patients with lower body weights initially experienced the same level of benefit as those with higher body weights. While many experts believe that weight loss plays a role, they argue that a molecule as complex as semaglutide involves multiple receptors on various tissues and mechanisms beyond simple weight reduction.
The trial left a few questions