Trial details

The data is based on the SELECT trial, a trial funded by Novo Nordisk, which makes semaglutide. The trial involved 17,604 overweight or obese adults over the age of 45 across 41 countries. All trial participants previously had a heart attack, stroke, or peripheral artery disease but did not have diabetes.

Participants in the trial were prescribed either a 2.4mg weekly dose of semaglutide or a placebo for an average of 40 months. The study found that the patients who took semaglutide had a 20% lower risk of heart attack, stroke, or death due to cardiovascular disease after three years of treatment regardless of whether they lost weight or not.

Of the 8,803 patients who took semaglutide, 6.5% experienced a primary cardiovascular end point, like a heart attack, compared to 8% of the 8,801 patients in the placebo group.

Another analysis, based on the same trial data, found that patients who took semaglutide typically lost weight for around 65 weeks, or a year and three months, before they hit a plateau. The research also found that the 10% average weight loss for those taking semaglutide was sustained for up to 208 weeks, or four years of treatment. Patients taking semaglutide stayed on the medication while they sustained this weight loss.

Overall, more patients taking semaglutide (17%) elected to stop participating in the trial because of side effects than those who received a placebo (8%). The side effects reported were mainly gastrointestinal disorders like nausea, diarrhea, vomiting, and constipation, which typically affected people in the first few months of the trial.

Discussion

John Deanfield, director of the National Institute for Cardiovascular Outcomes Research and lead author of the study, said the findings show that semaglutide should be routinely prescribed to treat cardiovascular illness.

"These findings have important clinical implications," he said. "Around half of the patients that I see in my cardiovascular practice have levels of weight equivalent to those in the SELECT trial and are likely to derive benefit from taking Semaglutide on top of their usual level of guideline-directed care."

"This fantastic drug really is a gamechanger," he added. "This [study] suggests that here are potentially alternative mechanisms for that improved cardiovascular outcome with semaglutide beyond weight loss … Quite clearly, something else is going on that benefits the cardiovascular system."

"The implications [of the trial] are profound," said Harlan Krumholz, a cardiologist and scientist at Yale University and Yale New Haven Hospital. "We have not encountered a drug with such a breadth of heart benefits."

Daniel Drucker, a researcher into GLP-1 drugs like semaglutide at the University of Toronto, noted that heart benefits come regardless of weight loss because "that's what GLP-1 does: It's cardio-protective, at least in animals, independent of whether or not you have diabetes, independent of whether you have obesity, and you don't require weight loss — it's not the whole story." (Hart, Forbes, 5/14; Thomas, The Guardian, 5/13; Tirrell, CNN, 5/13; Dewan, Newsweek, 5/14)

Advisory Board weight-related resources

According to CDC data, more than 70% of U.S. adults ages 20 and older are either overweight or obese. Obesity is also prevalent  among children, with rates growing between 17.7% and 21.5% over the last decade.

As obesity rates continue to rise, so will healthcare costs. Currently, obesity costs the U.S. healthcare system $173 billion every year.  

To help address the growing weight-related issues in healthcare, Advisory Board offers several resources on different topics, including:

GLP-1 drugs

Interest in new weight-loss drugs, including Novo Nordisk's Wegovy and Eli Lilly's recently approved Zepbound, has surged this year, leading to record sales — as well as supply shortages as manufacturers struggle to keep up with demand.

Advisory Board's Chloe Bakst and Rachael Peroutky  recently shared their insights on how GLP-1 shortages might impact healthcare and what leaders can do in the meantime.

Radio Advisory's Rachel Woods has also covered GLP-1 drugs on the podcast, discussing the  potential future of these drugs  and how they could help — or hurt —  health systems' finances.

Other useful resources include the expert insights  "5 catalysts that will impact the future of weight management drugs,"  and  "What the headlines get wrong about weight management medications."

Bariatric surgery

In 2022, the American Society for Metabolic and Bariatric Surgery and the International Federation for the Surgery of Obesity and Metabolic Disorders updated guidelines for weight-loss surgery, expanding eligibility for more people.

Under the new guidelines, anyone with a BMI over 35, regardless of their health status, is eligible for weight loss surgery. People with a BMI over 30, which is the official definition of obesity, are also eligible if they haven't been able to achieve substantial or long-term weight loss.

This expert insight outlines three barriers to bariatric surgery and how to overcome them. For patients considering bariatric surgery, this resource offers three factors they should keep in mind while they decide.

Meanwhile, this decision guide offers resources to help you build a successful weight management program that effectively attracts new patients struggling with obesity. It also guides patients through their care journey and keeps them engaged in the long term.

Healthcare's approach to obesity

Recently, healthcare organizations have made an effort to move away from using BMI to determine obesity and assess health. In June, the American Medical Association voted to adopt a new policy that moves away from using BMI alone when assessing whether a patient is at a healthy weight.

Some physicians are also looking beyond BMI and people's weight as they assess their health and recommend treatments. Instead of focusing on weight loss to treat health issues, some providers are now taking a "weight-neutral" approach that avoids intentional weight loss.

In a recent Radio Advisory episode, Rachel Woods and Advisory Board experts Darby Sullivan and Chloe Bakst discussed healthcare's current approach to obesity and whether it's helping or harming patients.

Similarly, this expert insight covers three missteps in our current approach to obesity, outlining five potential ways providers can address these issues.

Advisory Board cardiovascular resources

To learn more about the cardiovascular space, check out Advisory Board resources, including:

• This cheat sheet, which provides Advisory Board's predictions on key drivers, volume outlooks, and strategic imperatives that are driving (or slowing) growth in cardiovascular service lines.
• This research, in which we gathered 73 cardiovascular leaders to learn the most innovative strategies in cardiovascular care.
• This case study, which dives into how AdventHealth adjusted their cardiovascular ambulatory surgery center strategy.
• This slide deck, which will provide you with a ready-to-use presentation that will help you understand the major trends impacting cardiovascular care and implications for cross-industry stakeholders.

This webinar, occurring on May 23 at 1 p.m. ET, which will teach you about the newest trends in cardiovascular medicine and how they impact the future of care delivery.