GLP-1s for Heart Disease
In March 2024, the FDA approved the GLP-1 drug Wegovy (semaglutide) to treat heart disease in people who are overweight or who have obesity — the first approval for a GLP-1 medication outside of diabetes or weight loss.
The approval happened after participants in several GLP-1 trials experienced significant reductions in major cardiac crises such as heart attacks and strokes and fewer cardiovascular deaths, says Isaacs.
That would be expected, given obesity and excess weight are risk factors for heart attack and stroke. But other drugs (Trulicity, Victoza, Saxenda) and lifestyle interventions that have positive effects on glucose and weight haven’t demonstrated these types of impressive results, Isaacs points out. “This indicates that there are mechanisms that go well beyond just weight loss or glucose lowering,” she says.
In the Wegovy weight loss trial SELECT, people taking the drug had a 20 percent lower incidence of heart attack, stroke, or death from heart disease, compared with the placebo group, says Ard.
[2]
The weight loss in the SELECT trial wasn’t especially large — on average, each participant lost around 8 to 9 percent of their body weight. “This leaves open the question that there may be some other primary effect that is yet to be determined,” says Ard.
The SELECT trial was the first large, randomized study to show that a drug used for obesity could reduce cardiovascular disease, says Isaacs. “This may change the paradigm of how we view overweight and obesity” — as cardiovascular risk factors and not just cosmetic concerns — ”and will hopefully expand insurance coverage and access for these medications for weight loss,” she says.
Studies suggest that semaglutide is not only effective at reducing cardiovascular events when taken as an injection but also when taken in pill form.
[3]
