On Saturday (November 11) local time, Danish pharmaceutical giant Novo Nordisk said that its weight loss drug Wegovy can reduce the risk of cardiovascular disease, and that Wegovy's protective effect on the heart is not just an indirect effect of weight loss. Early data from the Select trial released by Novo Nordisk in August showed that Wegovy could help patients lose an average of 15% of their weight and reduce the incidence of heart attack, stroke or death from heart disease by 20%.
However, some believe that given that overweight and obesity are major risk factors for cardiovascular disease, Wegovy's benefits to the heart may be indirect through weight reduction, rather than a direct effect of the drug itself.
Novo Nordisk released the full results of the study, which was published Saturday in the New England Journal of Medicine at the American Heart Association's annual scientific meeting in Philadelphia. The findings suggest that Wegovy may have other beneficial effects in addition to its known health benefits of weight loss.
Researchers said the difference in heart disease risk among patients taking Wegovy, compared with a placebo control group, emerged almost immediately after starting treatment.
The study was based on body mass index and looked at overweight and obese patients who had heart disease but did not have diabetes. The data showed that Wegovy (chemical name semaglutide) reduced the risk of nonfatal heart attack by 28%, the risk of nonfatal stroke by 7%, and the risk of heart disease-related death by 15% compared with the placebo control group.
Novo Nordisk said that given that patients had not yet started losing weight when cardiovascular benefits first occurred, this suggests that Wegovy's heart-protective results are not purely a result of weight loss.
Researchers reported that patients taking Wegovy had a decrease in C-reactive protein, a sign of inflammation, similar to what is seen when taking cholesterol-lowering statins, which are known to significantly reduce heart disease risk.
Although understanding of the mechanisms of semaglutide's cardiovascular protection remains speculative, its effects on associated risk factors are consistent, supporting the idea that the drug has multiple clinical benefits, the researchers said. Related risk benefits include inflammation, blood pressure and blood sugar control, all of which can impact heart health.
Martin Lange, head of research and development at Novo Nordisk, said: "The cardiovascular benefits of (Wegovy) are the result of a combination of factors, but I would particularly emphasize blood sugar control, weight loss and inflammation."
The study showed that a total of 17,604 patients participated in the trial, with an average duration of 33 months. Nearly 1,500 of the patients taking Wegovy discontinued treatment due to adverse side effects, which mainly included gastrointestinal problems such as nausea and vomiting. In the placebo control group, 718 patients discontinued treatment.
Chad Weldy, a cardiologist at Stanford University, pointed out that the trial did not study how semaglutide prevented heart disease from occurring, but only how to prevent it from getting worse. Still, given the size of the patient population covered in the trial, doctors should start considering which patients to prescribe Wegovy based on the data.
"Anyone with heart disease or obstructive coronary artery disease and a body mass index of over 27 is eligible for this study, which is a very large group of patients," Weldy said.
Bruno Halpern, director of the Obesity Center at 9 de Julho Hospital in Sao Paulo, Brazil, also said that Wegovy should now become a first-line drug for the treatment of heart disease.
Barclays analyst Emily Field said it is unclear whether the study's results apply to GLP-1 (glucagon-like peptide-1) drugs or only to semaglutide.
Novo Nordisk said earlier this month that it had applied to U.S. and EU authorities in September and October for approval of Wegovy to reduce the risk of cardiovascular disease.