The obesity drug semaglutide (Ozempic) may significantly reduce the risk of heart attacks and other serious cardiovascular events in overweight people, including patients with heart failure.
The anti-obesity drug semaglutide – the active ingredient in Ozempic and Wegovy – could help prevent heart attacks and other serious cardiac events in overweight people with cardiovascular disease, regardless of whether they also have heart failure, according to a new study led by UCL Professor John Deanfield.
These results add to previous research from the same international team, which showed that weekly semaglutide injections were associated with a 20% reduction in major adverse cardiac events (MACE), such as heart attacks and strokes, in people with obesity or overweight and with cardiovascular disease.
The new study, published in The Lancet, found similar cardiovascular benefits in a subgroup of participants who were also diagnosed with heart failure at the start of the trial (i.e., whose hearts were not pumping blood properly).
Researchers analyzed data from 4,286 people, out of a total of 17,605 in the SELECT study, who were randomly assigned to receive semaglutide or placebo and followed for an average of more than three years. They found that semaglutide was associated with a 28% reduction in major adverse cardiac events (12.3% in the placebo group vs. 9.1% in the semaglutide group), a 24% reduction in cardiovascular-related deaths in this subgroup with pre-existing heart failure, and a 19% reduction in deaths from any cause.
Benefits of semaglutide for people with heart failure
Professor John Deanfield from the UCL Institute of Cardiovascular Sciences and senior author of the study, said: “Our previous analysis from the SELECT study showed the benefits of semaglutide for people with cardiovascular disease who were obese or overweight. This new study shows that, within this group, people with heart failure performed as well as those without heart failure on the parameters we measured.”
“This is important as there were concerns that semaglutide could be harmful to people with a type of heart failure known as reduced ejection fraction, where the heart pumps less blood to the body. Our findings show that the benefit of semaglutide was similar regardless of the type of heart failure.”
Semaglutide is a GLP-1 receptor agonist that mimics the functions of the body’s natural incretin hormones, which help lower blood sugar levels after a meal. It was initially prescribed for adults with type 2 diabetes.
The exact mechanism by which semaglutide provides cardiovascular benefits is not known for certain, but may be related to its positive effects on blood sugar, blood pressure and inflammation, as well as direct effects on heart muscle and blood vessels. The researchers suggest that the reduction in all-cause mortality in all heart failure groups “indicates the potential for other as yet unknown benefits.”
The clinical benefit of semaglutide was independent of the type of heart failure, as well as age, sex, initial BMI and clinical status.
The study compared the impact of semaglutide in people with two types of heart failure: preserved ejection fraction, where the heart pumps blood normally but is too stiff to fill properly, and reduced ejection fraction. These two types of heart failure have different causes and respond differently to treatments, with preserved ejection fraction, the most common type, not responding as well to traditional treatments, representing an unmet clinical need.
The investigators found that the clinical benefit of semaglutide was independent of the type of heart failure, as well as age, sex, baseline BMI, and clinical status. Serious adverse events were reported more frequently in the placebo group than in the semaglutide group. Treatment was discontinued more often in the semaglutide group, mainly due to gastrointestinal disorders (14.7% vs. 9.0% in the heart failure groups; and 17.2% vs. 7.9% in the non-heart failure groups).
These findings support the use of semaglutide, in addition to usual care, to reduce the risk of major adverse cardiac events in a broad population of people with established atherosclerotic cardiovascular disease and overweight or obesity.
The researchers noted that further trials are needed to assess the impact of semaglutide on heart failure-related outcomes. Because the SELECT study was not a heart failure-specific trial, they cautioned that the results cannot be extrapolated to heart failure patients in general.
