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study highlights wegovy's expanding benefits from obesity to heart disease
5 minute read
dr. subodh verma was also part of other studies looking into using semaglutide in the treatment of heart disease driven by obesity, and the results of those trials were just as promising.
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wegovy (semaglutide), a drug originally intended to help people manage obesity, has recently gained traction in the field of other treatments—namely heart disease.
since wegovy has already been proven to help reduce weight, manage blood sugar, and reduce major adverse cardiovascular events (mace), such as heart attack and stroke, in people with obesity, a new goal was put forth by researchers: to see if the drug would reduce cardiovascular complications that arise in people with obesity or overweight without the presence of diabetes.
an international, large-scale, randomized, placebo-controlled trial evaluating the efficacy of wegovy, known as the select trial, was conducted using participants from 41 countries who were over the age of 45 and had a body mass index (bmi) over 27, indicating overweight or obesity.
as it turns out, wegovy may be much more beneficial than once thought, as evidenced by the results of the select trial and other studies done to date. the canadian lead trial investigator and renowned cardiac surgeon-scientist at st. michael’s hospital in toronto, dr. subodh verma, oversaw canadian participation and enrolment in the trial.
his work with semaglutide helped establish the results of the current research, showing that the benefits of these medications were far more impressive than initially thought.
“what emerged from the data set in people with diabetes … the benefit of these medications to reduce major adverse cardiovascular events was agnostic to whether they had high sugar or not,” he said.
heart disease in canada
according to the heart and stroke foundation of canada, nine out of every ten canadians have at least one risk factor for heart disease, stroke, or vascular cognitive impairment and every five minutes, one canadian dies of a heart-related condition. in people with obesity, overweight, or diabetes, the risks are even more significant.
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as the second leading cause of death in canada, the treatment and reduction of risks is paramount to helping canadians improve their quality of life as well as their lifespan.
“there’s a large number of people in canada that have had a myocardial infarction or stroke or have established disease,” dr. verma said.
using wegovy in the treatment of heart disease
the treatment of heart disease often involves a multipronged approach, including medications, lifestyle changes, and surgeries. still, the impact treatment has isn’t always the most positive, especially for people who have had previous maces or other comorbidities, such as diabetes and obesity.
in the select trial, it was shown that wegovy could be a new option for the treatment of obesity-related maces in people without diabetes.
“that was one of the reasons why the thought was, are these medications just medications to lower sugar, or are they therapies to truly treat major adverse cardiovascular events (maces), even in people who don’t have diabetes,” said dr. verma.
“that was really the rationale leading up to the select trail to say, can we ask the question of whether weight is important and whether these drugs are truly anti-atherosclerotic or drugs that reduce major adverse cardiovascular events irrespective of diabetes because we know that if you have diabetes, these drugs can be used to improve sugar control, to improve kidney function, to lose weight.”
dr. verma was also part of other studies looking into using semaglutide in the treatment of heart disease driven by obesity, and the results of those trials were just as promising.
“the story began to emerge from there that it was suggested that not only was it shown that these drugs helped people living with diabetes control their sugar, but they also had, surprisingly, two other benefits,” he said. those two other benefits were, as mentioned above, treating heart disease without the presence of diabetes and treating overweight and obesity.
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the other studies that dr. verma participated in, known as step-hfpef and step-hfpef dm, also examined the role of semaglutide medications, such as wegovy, as they related to other types of heart disease.
one type, heart failure with preserved ejection fraction, which is a form of heart failure that presents with symptoms despite having near-normal results in the left ventricle area of the heart, also found the drugs effective. almost half of people who develop heart failure fall into the preserved ejection fraction category.
these trials had the primary goal of further understanding the role semaglutide medications could have in heart disease as it related to obesity.
“gaining weight and overweight and obesity triggers changes in inflammation and immune dysregulation that are pathophysiologically linked to the genesis or development of this problem (heart failure),” dr. verma said. “so, we have never been able to test the hypothesis adequately as to whether obesity and overweight are truly pathophysiologically causal in the development of heart failure with preserved ejection fraction, and then, can treating overweight and obesity actually be a treatment for this condition.”
semaglutide medications can also improve the quality of life in people with heart failure with preserved ejection fraction, emphasizing even further their role in the treatment of various heart diseases.
“it (quality of life) is probably just as important if not more than (prolonging life) … to make life more livable for patients, right? dr. verma said. “this has to be a primary objective of doctors to actually listen to what the patient is saying, improve their symptoms, reduce morbidity, make life more livable. and some of the things we saw in this trial was that patients’ social functioning improved.”
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future directions for wegovy
the results of the select trial and other studies dr. verma was a part of speak for themselves, in a way, showing that the connection between wegovy and heart disease is more beneficial than researchers could have imagined. but dr. verma acknowledges that it might be hard for people to come to terms with the benefits of the medication, especially since it was initially used for something—while connected—entirely different.
“i think that people need to know that this is a formidable strategy to reduce cardiovascular, renal, (and) heart failure outcomes, and it lowers weight,” he said. “but the benefits … that is so hard for people to get their head around to say, how could a drug have five benefits?”
what dr. verma means is that this drug, after all its trials, is showing promise in the treatment of cardiovascular events, heart failure, obesity and overweight, diabetes, and kidney disease. as for where wegovy can go, dr. verma is excited about his patients’ future now that another effective and viable treatment modality is on the horizon.
“i’m really excited and very, very impressed with where we are in the field right now. i think the achilles heel now is … how do we actually get it from the new england journal translated into appropriate care?” he said. “those are the next steps.”
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