Heart Health
Anti-obesity drug lowers heart-related problems
But because semaglutide and related drugs are so popular, they can be hard to find — and they might not be covered by your insurance.
- Reviewed by Christopher P. Cannon, MD, Editor in Chief, Harvard Heart Letter; Editorial Advisory Board Member, Harvard Health Publishing
Semaglutide — the highly in-demand drug that leads to dramatic weight loss — may also prevent heart attacks, strokes, and deaths in people with heart disease. This finding, reported in The New England Journal of Medicine (NEJM) in the fall of 2023, marks the first time an treatment for obesity has been shown to help people live longer and have fewer cardiovascular problems (see "Diet drugs: A disheartening history").
Developed as a drug for treating type 2 diabetes, semaglutide was first marketed as Ozempic. In addition to improving blood sugar control, the drug also helped people lose substantial amounts of weight. After studies confirmed this benefit, the FDA approved a higher-dose version of semaglutide (sold as Wegovy) for people who are overweight or obese.
Diet drugs: A disheartening historyFor decades, drug companies have struggled to develop an effective, safe drug to help people lose weight. "But many initially promising drugs never made it through the development phase, and others had to be pulled from the market," says Dr. Benjamin Scirica, associate professor of medicine at Harvard Medical School. The most infamous example dates from 1997. A combination of two drugs, fenfluramine and phentermine (commonly known as phen-fen) was removed from pharmacy shelves after people taking the drug developed severe heart valve disease and pulmonary hypertension. In 2010, sibutramine (Meridia) was also withdrawn from the market after studies linked its use to a heightened risk for heart attack and stroke. |
Evidence for heart benefits
The NEJM study compared a 2.4-milligram dose of semaglutide (the highest dose of Wegovy) to a placebo in more than 17,000 people with cardiovascular disease. All were overweight or obese, but none had diabetes. Over a follow-up period averaging 3.3 years, those who took semaglutide were 20% less likely to have a heart attack or stroke or to die from heart-related causes compared with those who took a placebo.
"The findings highlight the fact that obesity is a risk factor for cardiovascular disease," says Dr. Benjamin Scirica, a cardiologist with Harvard-affiliated Brigham and Women's Hospital. People taking semaglutide lost an average of nearly 19 pounds, which probably explains why their blood pressure, triglycerides, LDL cholesterol, and inflammation levels all improved. However, other factors could also be involved, he says.
A hormone mimic
Semaglutide belongs to a class of drugs known as GLP-1 receptor agonists (GLP-1s) that mimic hormones made naturally by the gut and brain. These drugs prod the pancreas to release insulin, which helps control blood sugar. They also slow stomach emptying and suppress appetite, so people eat less. But there are also GLP-1 receptors in the heart, kidneys, and blood vessels, which means some of the heart-related benefits may be unrelated to weight loss, says Dr. Scirica.
A related drug, terzepatide, combines GLP-1 with GIP, a hormone believed to promote the effects of GLP-1. Sold as Mounjaro for treating diabetes and as Zepbound for weight loss, terzepatide appears to foster even greater weight loss than semaglutide. A clinical trial testing terzepatide in people with obesity and a high risk of heart disease is currently under way.
Who's a candidate?
Anyone with type 2 diabetes is a candidate for either Ozempic or Mounjaro. "I have many patients doing well on these drugs, and they are usually covered by insurance," says Dr. Scirica. Still, only about 30% of people with cardiovascular disease have diabetes. A far greater percentage — well over 50% — of people with cardiovascular disease are overweight or obese.
Wegovy and Zepbound are FDA-approved for weight loss in people who meet the definition of obesity (a body mass index, or BMI, of 30 of greater) and for those who fall into the upper end of the overweight category (a BMI of 27 to 29.9) and also have a medical problem related to excess weight, such as high blood pressure or high cholesterol. But the overwhelming demand for these drugs means they're in short supply, Dr. Scirica says. They're also quite expensive, ranging from $900 to $1,600 per month. Medicare does not cover any medications for weight loss, although some private insurance companies do.
However, given the intense interest and enthusiasm about these drugs, experts believe that recommendations as to who should use them will change in the coming years. What can you do in the meantime? "Call your insurance company to see what your options are based on your current medical conditions, then speak with your physician," advises Dr. Scirica.
Image: © Jose Luis Pelaez Inc/Getty Images
About the Author
Julie Corliss, Executive Editor, Harvard Heart Letter
About the Reviewer
Christopher P. Cannon, MD, Editor in Chief, Harvard Heart Letter; Editorial Advisory Board Member, Harvard Health Publishing
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