Heart disease remains the leading cause of death in the UK, claiming over 160,000 lives annually. While advancements in treatment exist, preventing heart attacks altogether is a crucial public health goal. Recent research findings suggest a potential game-changer: weight loss medication showing promise in reducing heart attack risk.
This blog delves into the exciting developments surrounding semaglutide, a weight loss jab, and its potential impact on heart health. We’ll explore how it works, the results of key clinical trials, and what this means for the future of heart disease prevention.
Understanding the Link Between Weight and Heart Health
Obesity is a major risk factor for heart disease. Excess weight contributes to various factors that can damage the heart and blood vessels, including:
- High blood pressure: Excess weight strains the heart, leading to elevated blood pressure.
- Unhealthy cholesterol levels: Obesity can promote an increase in “bad” LDL cholesterol and a decrease in “good” HDL cholesterol.
- Insulin resistance: Obesity can lead to insulin resistance, a condition where the body struggles to use insulin effectively, which can further contribute to heart disease risk.
These factors can lead to plaque buildup in arteries (atherosclerosis), which narrows blood vessels and increases the risk of blood clots. This, in turn, can trigger heart attacks (myocardial infarction) and strokes.
What is Semaglutide & How does it work?
Semaglutide is a glucagon-like peptide-1 (GLP-1) receptor agonist, a medication that mimics the actions of a natural gut hormone called GLP-1. This hormone plays a crucial role in regulating blood sugar levels and appetite. Semaglutide is a medication available in the UK by prescription under two brand names:
- Ozempic: This is the licensed brand for treating type 2 diabetes, but clinicians prescribe it off-label for weight management in some cases. Starts with a lower dose (usually 0.25mg) and may be gradually increased to a maximum of 2mg.
- Wegovy: This is the newer brand name specifically licensed for weight management. Starts at a similar dose (0.25mg) but can be titrated up to a higher maximum of 2.4mg over a longer period.
Both Ozempic and Wegovy are administered as injectable medications, typically once a week.
Here’s how semaglutide is thought to work:
- Boosting Insulin: Semaglutide encourages your pancreas to produce more insulin. Insulin acts like a key, helping your cells absorb glucose (sugar) from the bloodstream, which lowers your blood sugar levels.
- Curbing Cravings: Semaglutide interacts with receptors in your brain that control appetite. This can lead to increased feelings of fullness and reduced hunger pangs, making you feel less inclined to overeat.
- Slowed Digestion: Semaglutide might slow down how quickly food moves out of your stomach. This can prolong feelings of satisfaction after meals and help you resist unhealthy snacking.
Clinical Trials: Promising Results for Weight Loss and Heart Health
The efficacy of semaglutide for weight management has been extensively studied. The landmark Semaglutide and Cardiovascular Outcomes in People with Overweight or Obesity (SELECT) trial, involving over 9,500 participants, demonstrated significant weight loss in individuals receiving semaglutide compared to those on a placebo. On average, participants lost around 15% of their body weight after two years.
More importantly, the SELECT trial revealed a groundbreaking secondary benefit: a substantial reduction in cardiovascular events. Those taking semaglutide experienced a 26% decrease in the risk of major adverse cardiovascular events (MACE), including heart attacks and strokes. This finding suggests that semaglutide may have a role beyond weight management, potentially offering protection against heart disease.
The article published by BBC yesterday (14th May 2024) on Semaglutide shows promise for heart health, regardless of weight loss. A new analysis of the SELECT trial, presented at a recent conference but not yet published in a journal, suggests semaglutide offers heart benefits beyond weight loss.
Here’s the key takeaway from the article:
- Latest clinical results: The analysis focused on the time it took for participants to develop a major adverse cardiovascular event (MACE), which includes heart attacks, strokes, and heart failure.
- After receiving semaglutide for 20 weeks, a significantly higher percentage (62%) lost more than 5% of their body weight compared to the placebo group (10%).
- Importantly, even patients who lost little weight or gained weight on semaglutide seemed to experience similar reductions in heart attack, stroke, and heart failure risk.
- Prof. Deanfield suggests this is promising, as many of his heart patients have similar weight levels to those in the study and could potentially benefit.
- Reduced heart risks: Those taking semaglutide had a lower risk of heart attacks, strokes, and heart failure compared to placebo, regardless of how much weight they lost.
- Potential mechanisms: Professor John Deanfield, who led the research, suggests semaglutide may improve blood sugar, blood pressure, and inflammation, or directly impact the heart and blood vessels. However, the exact mechanisms need further study.
- Comparison to statins: Prof. Deanfield sees this as a potential breakthrough similar to the introduction of statins for cholesterol, potentially transforming treatment for chronic age-related diseases.
- Caution needed: Professor Rameen Shakur, a heart specialist, urges caution as the biological mechanism is unclear and potential side effects like pancreatitis and rare thyroid cancers exist.
Overall, this unpublished data suggests semaglutide may have significant benefits for heart health, even without major weight loss. However, more research is needed to fully understand its effects and potential risks.
Unveiling the Mechanism Behind Reduced Heart Attack Risk
The precise mechanism by which semaglutide reduces heart attack risk is still under investigation. However, several potential explanations are being explored:
- Improved blood sugar control: By lowering blood sugar levels, semaglutide might help prevent damage to blood vessels and reduce the risk of plaque buildup.
- Reduced blood pressure: Semaglutide may have a modest blood pressure-lowering effect, further contributing to cardiovascular health.
- Anti-inflammatory properties: Studies suggest semaglutide might possess anti-inflammatory properties, which could be beneficial for heart health as chronic inflammation is linked to cardiovascular disease.
Semaglutide- Weight Loss Jab : A Game Changer
The results of the SELECT trial are undoubtedly promising. Semaglutide offers a potentially powerful tool for weight management, and the observed reduction in heart attack risk is particularly exciting. However, it’s important to consider some key points:
- Eligibility: Semaglutide is not a one-size-fits-all solution. It’s currently indicated for specific patient groups, such as those with obesity and type 2 diabetes. Further research is needed to determine its effectiveness in broader populations.
- Long-Term safety: While initial studies show promising safety profiles, long-term use of semaglutide requires ongoing monitoring.
- Lifestyle modifications: Semaglutide should be used alongside healthy lifestyle changes, including a balanced diet and regular exercise, for optimal weight management and heart health.
In Summary
Semaglutide represents a significant advancement in the fight against obesity and its associated health risks. Ongoing research is exploring its potential benefits in various patient populations and its long-term safety profile.
Additionally, scientists are investigating how semaglutide might interact with other medications and lifestyle interventions for an even more comprehensive approach to weight management and cardiovascular disease prevention.
References:
- CDC (2023) Know your risk for heart disease, Centers for Disease Control and Prevention. Available at: https://www.cdc.gov/heartdisease/risk_factors.htm.
- Facts and figures (no date) British Heart Foundation. Available at: https://www.bhf.org.uk/what-we-do/news-from-the-bhf/contact-the-press-office/facts-and-figures.
- Health matters: preventing cardiovascular disease (no date) Gov.uk. Available at: https://www.gov.uk/government/publications/health-matters-preventing-cardiovascular-disease/health-matters-preventing-cardiovascular-disease.
- Lincoff, A. M. et al. (2023) “Semaglutide and cardiovascular outcomes in obesity without diabetes,” The New England journal of medicine, 389(24), pp. 2221–2232. doi: 10.1056/nejmoa2307563.
- Loewy, M. A. (2024) What’s next in the Ozempic era?, Asbmb.org. Available at: https://www.asbmb.org/asbmb-today/science/051124/what-s-next-in-the-ozempic-era
- Mackintosh, T. (2024) “Weight loss jab could reduce heart attack risk, study finds,” BBC, 14 May. Available at: https://www.bbc.com/news/articles/cd188m73vn1o
- Marso, S. P., Bain, S. and Consoli, A. (2016) “Semaglutide and cardiovascular outcomes, efficacy and safety in type 2 diabetes,” New England Journal of Medicine.
- Nordisk, N. (2016) Semaglutide reduced major cardiovascular events by 26% in adults with type 2 diabetes at high cardiovascular risk, PR Newswire. Available at: https://www.prnewswire.com/news-releases/semaglutide-reduced-major-cardiovascular-events-by-26-in-adults-with-type-2-diabetes-at-high-cardiovascular-risk-593658161.html
- Rackham, A. (2023) “Weight loss drug semaglutide approved for NHS use,” BBC, 8 March. Available at: https://www.bbc.com/news/health-64874243
- Wise, J. (2023) “Semaglutide reduces risk of major cardiovascular events by 20%, finds study,” BMJ (Clinical research ed.), 383, p. 2668. doi: 10.1136/bmj.p2668.
- Wu, W. et al. (2023) “The effect of semaglutide on blood pressure in patients with type-2 diabetes: a systematic review and meta-analysis,” Endocrine, 83(3), pp. 571–584. doi: 10.1007/s12020-023-03636-9.
- Yaribeygi, H. et al. (2024) “Anti-inflammatory benefits of semaglutide: State of the art,” Journal of clinical & translational endocrinology, 36(100340), p. 100340. doi: 10.1016/j.jcte.2024.100340.
