Drugs such as Ozempic and Wegovy that have transformed how doctors treat diabetes and obesity could also protect against heart disease, according to a new study.
Research published in The Lancet looked at the heart health of 17,604 overweight or obese patients aged over 45 to see how they responded to semaglutide, which is found in both drugs and widely used in the UAE.
Both Ozempic and Wegovy contain the molecule semaglutide, and are prescribed to control diabetes and weight loss respectively.
Scientists explored the impact on cardiac health of the higher semaglutide dose found in Wegovy.
People enrolled in the Select study in 41 countries took either a 2.4mg dose once a week, or a placebo.
Changes in weight and waist circumference were monitored over 104 weeks, as well as any risk associated with major adverse cardiovascular events such as cardiovascular death, non-fatal myocardial infarction (commonly known as a heart attack), or non-fatal stroke.
While observed cardiac benefits occurred in a third of patients who lost weight, two thirds saw similar benefits without losing weight or reducing their waistlines.
“This was a very large study with high-risk patients without diabetes, which showed semaglutide was effective in reducing the cardiovascular deaths, myocardial infarction and strokes, irrespective of weight loss,” said Dr Brajesh Mittal, interventional cardiologist at Medcare Hospital in Al Safa, Dubai.
“The results were remarkable in the sense that the molecule itself was in ways other than just weight reduction, helping in reducing these cardiovascular events.
“This can have a very big implication in our patient population, by reducing inflammation inside the arteries of the heart, as well reducing blood pressure.”
Biggest killer
A 2021 study by Cleveland Clinic Abu Dhabi found more than 55 per cent of residents in the emirate had been impacted by heart disease, with 12 per cent personally diagnosed.
It is the leading cause of death in the UAE, accounting for around 34 per cent. Almost half of those admitted to hospital with a serious cardiac event were under the age of 50.
The Select study showed the level of weight loss did not relate to subsequent benefits to heart health, and while changes in waist circumference were more significant, it explained the benefits in only 33 per cent of people.
“As the UAE has a very large population of either high risk or those who have already suffered heart-related issues, these patients are likely to potentially benefit,” said Dr Mittal.
“However, there is clearly a cost implication of the medication, without doubt. Eventually, when something is used more frequently and produced in bulk … the cost will come down.
“We are seeing a new horizon of several therapies, which will help us reduce the number of events and mortalities in patients with cardiovascular diseases.”
Semaglutide products require a prescription in the UAE and cost from around Dh700 to Dh3,000, depending on the dose and brand.
Naturally occurring GLP-1 and the synthetic form semaglutide have a similar impact on the body’s hormones. When we eat, GLP-1 is released in the gut to control blood glucose and make us feel full.
The modified version, semaglutide, remains active in the body for longer so has a broader impact. Semaglutide activates parts of the brain that control food intake to reduce hunger and cravings.
It increases a feeling of fullness and aids the pancreas to increase the release of insulin, and decrease glucagon to regulate blood glucose. It also causes a slight delay in the emptying of the stomach to further lower glucose levels.
Multiple benefits
Meanwhile, semaglutide benefits the cardiovascular system. The drug has been found to improve blood sugar and cholesterol levels, reducing body weight, as well as lowering blood pressure and inflammation.
It also aids the liver by reducing glucose production, improving how the body uses insulin and decreasing the harmful accumulation of fat and inflammation.
Although the direct reasons for the benefit to heart health are not fully understood, doctors said semaglutide offered vascular protection to help avoid blocked arteries and control blood pressure and lipids, which could lead to a stroke or heart attack.
Dr Job Simon, an endocrinologist at Burjeel Hospital in Abu Dhabi, said the stumbling block of insurance coverage should not stand in the way of more patients accessing the drug.
“These molecules have been around for about seven years now, but this is the first study that showed these benefits in non-diabetic patients,” he said.
“These were people who already had an established heart problem but none of them were diabetic.
“Cost is the biggest issue. Insurance companies are now covering semaglutide for obesity, but only for people with a BMI of at least 30. No insurers are covering this drug for cardiac issues.
“I was convinced the positive results in the study were because of the weight loss, but that was only seen in a third of subjects, which suggests the benefit is due to something else the molecule is doing.”
Future of health care
Danish pharmaceutical giant Novo Nordisk has led the way in the GLP-1 drug market, launching Saxenda in 2014 and Wegovy in 2021, a high dose formulation of semaglutide.
Maziar Mike Doustdar, chief executive of Novo Nordisk, said the latest research shows potential to expand the use of semaglutide for patients beyond those requiring weight loss or diabetes control.
“This is exactly why Novo Nordisk is focused on bringing innovation to more people – to help treat the multiple chronic diseases that often go hand in hand,” he said.
“We're not just addressing one condition in isolation, but the interconnected web of health challenges people face.
“The science behind these medicines tells a story about treating the whole person, not just individual symptoms. That's the future of health care.”
