- Preventing major adverse cardiovascular events like heart attacks and strokes is better than treating them.
- Research about potential prevention strategies, including the use of semaglutide, a drug used to treat type 2 diabetes and aid weight loss, is ongoing.
- Results of a secondary analysis found that semaglutide may help decrease the risk of death from any cause, death from cardiovascular causes, combined heart failure outcomes, and major adverse cardiovascular events after just six months of receiving semaglutide.
A recent secondary analysis of a study shared at the 32nd European Congress on Obesity helps to further demonstrate that the benefits of semaglutide begin early. It builds on the findings from a study published in 2023 in the New England Journal of Medicine, which found that weekly injections of semaglutide helped to decrease the risk of stroke, heart attack, or death from cardiovascular causes.
At just three months, before dose titration was over, participants on semaglutide had a noted decreased risk for stroke, heart attack, or cardiovascular death, with additional benefits at six months.
The findings suggest an early advantage of taking semaglutide for people with cardiovascular disease who are overweight or obese.
This study included 17,604 participants who were overweight or obese and already had cardiovascular disease. About half of the participants received semaglutide while the other half received the placebo.
The researchers found that participants who received semaglutide had a 20% decreased risk of experiencing non-fatal heart attacks, non-fatal strokes, or death from cardiovascular causes. The average follow-up time with participants was 39.8 months, and the average time participants took semaglutide was 34.2 months.
This secondary analysis focused on heart health in the first six months after participant randomization. The results suggest that the cardiovascular benefits of semaglutide could begin fairly early on.
At three months, researchers found that participants who received semaglutide had a decreased risk for major adverse cardiovascular events (MACE), which included non-fatal heart attack, non-fatal stroke, or cardiovascular death.
These findings occurred even before there was significant weight loss among participants in the semaglutide group and even before participants had reached the full dose of semaglutide.
Typically, people start on a lower dose of semaglutide and build up to receiving a 2.4 mg dose of semaglutide. The titration timeframe usually lasts sixteen weeks, and researchers of the 2023 study followed this typical timeline.
At four weeks, semaglutide participants had an average difference in body weight of 1.1% lower than those in the placebo group. At 12 weeks, the average weight difference was 3.6% lower in the semaglutide group compared to the placebo group.
At six months, researchers observed similar outcomes for MACE. They also found the semaglutide group had a decreased risk for death from any cause, death from cardiovascular causes, and the measured heart failure composite, which included having an urgent medical visit or hospitalization from heart failure and death from cardiovascular causes.
Patrick Kee, MD, PhD, a cardiologist at Vital Heart & Vein, who was not involved in the study, noted the following about the study’s results:
“The investigators demonstrated that the therapeutic efficacy of semaglutide on the primary cardiovascular composite endpoint indeed emerged early and persisted over the initial three months (hazard ratio [HR] 0.63, 95% confidence interval [CI] 0.41-0.95) and the subsequent six months (HR 0.60, 95% CI 0.44-0.81).”
“While the underlying mechanisms of semaglutide’s early clinical benefits remain under investigation, these findings suggest an encouraging intervention capable of altering the trajectory of [patients with obesity] with established cardiovascular disease but without a diagnosis of diabetes,” he told Medical News Today.
The full secondary analysis is unavailable, so it is not entirely clear what the research limitations are. This initial report lacked some information that will become available at the time of full study publication.
“Additional analyses of the early MACE separation for semaglutide versus placebo by individual MACE components, additional clinical outcomes, patient subgroups, and other parameters changing during the early post-randomisation stages of the trial will be provided,” the authors note.
Thus, it’s not entirely clear what the outcomes are for some individual endpoints at this time, and this will be clearer when the full study is available.
The secondary analysis would also carry similar limitations to the original study. For example, the original research focused on people who already had cardiovascular disease and did not have diabetes, and all participants were at least 45 years old. The results could be different in other groups with other criteria in place.
Less than 30% of participants were women, and there was a relatively low number of Black participants. Thus, the sample did not represent the global population.
It may be beneficial to verify the findings of this analysis in other study samples. The authors of the secondary analysis also note that research can further focus on why semaglutide produced the effects they observed.
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These analysis results suggest the benefits of semaglutide, even in the short term, regarding cardiovascular outcomes in at-risk individuals. This research could help expand the prevention of deaths related to cardiovascular problems.
Cheng-Han Chen, MD, a board certified interventional cardiologist and medical director of the Structural Heart Program at MemorialCare Saddleback Medical Center in Laguna Hills, CA, who was also not involved in the study, said:
“This study suggests that patients overall receive a benefit to cardiovascular health with semaglutide early in their treatment course even before losing significant body weight. As there are a certain proportion of patients who do not actually lose significant weight with semaglutide treatment, it may potentially be worthwhile to keep these patients on therapy for this reason despite not losing weight.”
“This study gives us more information on the timing of the cardiovascular benefit of semaglutide. This will help us to design treatment programs for our patients and provides a benchmark for comparison of future therapies,” he told MNT.
