Semaglutide can protect you from the risk of heart attack too, says study

Semaglutide belongs to a new class of diabetes medicines called GLP-1 agonist. The drug mainly acts on the gut and mimics the action of incretins — a group of hormones released when we eat food. The incretins are responsible for regulating levels of insulin and glucagon. The medicine increases insulin secretion which is used to process the glucose in the blood and reduces glucagon secretion which is known to stimulate glucose production. The medicine also reduces storage of glucose in the liver.

Semaglutide is available as Ozempic (injectable) and Rybelsus (oral) for the treatment of Type-2 diabetes.

The use of incretin pathway by the medicine also results in suppression of appetite and feeling fuller with smaller portions. This is what leads to weight loss. The medicine is available as Wegovy in a higher 2.4mg once-a-week injectable dosage for weight loss.

The medicine has been shown to reduce weight by 15 per cent in overweight or obese individuals, with a third of the study participants losing up to 20 per cent of their body weight. Experts have said this is exceptional; no weight-loss method other than bariatric surgery can lead to so much weight loss.

What is the impact of the medicine on heart health?

With the medicine keeping blood glucose levels in control and helping people lose weight, it is not surprising that it reduces major cardiovascular adverse events. Obesity, diabetes, and hypertension are the most common risk factors for these heart conditions.

A trial in overweight or obese people without diabetes found that the medicine reduced the risk of heart attacks, strokes, and other cardiovascular conditions and related deaths by 20 per cent, the company Novo Nordisk announced earlier this week. The trial included 17,604 adults over the age of 45 years who were obese or overweight and were given the higher dosage recommended for weight-loss.

Dr VK Bahl, principal director of cardiac science at Max Hospitals, said that the company has shown benefits to the cardiac health in not just the dose recommended for the treatment of Type 2 diabetes but also the higher dose recommended for weight-loss. He said: “After diabetes drugs glitzones introduced nearly 20 years ago were found to increase risk of heart failure, regulatory authorities mandated that diabetes drugs would not be approved unless they were beneficial for the heart as well.”

Martin Holst Lange, executive vice president for Development at Novo Nordisk, in a release said: “People living with obesity have an increased risk of cardiovascular disease but to date, there are no approved medications proven to deliver effective weight management while also reducing the risk of heart attack, stroke or cardiovascular death. Therefore, we are very excited about the results from SELECT showing that Semaglutide 2.4 mg reduce the risk of cardiovascular events.”

Who will benefit from using the drug? And, how often does it need to be taken?

Doctors say Semaglutide is the most beneficial for overweight and obese individuals with diabetes. The medicine, however, has been approved for weight-loss alone as well. The updated guidelines of the American Heart Association released last month also recommend wider use of the medicine in those without diabetes.

However, doctors do not recommend the use of the medicine in people with normal BMI trying to shed a few kgs. In addition, they say that people have to continue making lifestyle changes such as eating healthier and eating regularly.

The injection has to be taken once a week.

Dr Rakesh Yadav, professor of cardiology at the All India Institute of Medical Sciences, said: “The GLP-1 agonists have shown good results in controlling diabetes and obesity over and above the conventional therapies. But these are incremental benefits.”

And, what about the cost of the medicine?

The cost is the major barrier when it comes to the adoption of the medicine. Although the weight-loss dosage is not approved yet in India, it is available on demand. It can cost anywhere between Rs 12,000 to 20,000 a month. The cost may also depend on availability as there is already a shortage of the medicine in the US.

Dr Yadav said: “It can help overweight and obese people with diabetes. However, cost is a major issue. If a person can afford it, well and good. But if I ask my patients to spend thousands of rupees on a single medicine every month, they will go hungry and are more likely to have adverse outcomes.”

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(Source: INDIAB study)