The hottest medication in the world got even hotter this week after Novo Nordisk revealed that its weight loss drug Wegovy (semaglutide) also reduces major cardiac event risks by 20% – a revelation that could change how GLP-1s are used, perceived, and reimbursed.
Novo Nordisk’s double-blinded SELECT trial gave either semaglutide (2.4 mg weekly) or a placebo to 17,604 non-diabetic obese adults with cardiovascular disease (≥45yrs, mean BMI 33, 41 countries, 800 sites) in addition to standard of care.
Over a 5-year follow up period, the semaglutide group…
- Had a 20% lower risk of major cardiovascular events
- Achieved reductions in cardiovascular death, heart attacks, and stroke
- Showed that semaglutide was safe and well-tolerated, matching previous trials
Although the complete study hasn’t been released, these topline results were widely viewed as among the most significant from a preventative cardiology trial in recent memory. They also sparked a frenzy on CardioTwitter, and widespread coverage across cardiology and mainstream news sites, while driving a massive 14% surge in Novo Nordisk’s stock price in a single day.
And for good reason. If semaglutide and other GLP-1s are proven to truly slash CV events by a fifth it could…
- Improve the cardiovascular health of an untold number of GLP-1 users
- Prompt the FDA to approve semaglutide for CV risk reduction
- Pressure Medicare and commercial payors to finally cover weight loss drugs
- Reverse critical narratives around weight loss medications
- Solidify cardiology’s role in weight and cardiometabolic care
- Further expand the (already massive) value of the weight loss segment
On a more scientific note, SELECT also prompted some interesting discussions regarding what’s driving semaglutide’s CV event reductions (e.g. directly from weight loss, cardiometabolic improvements, vascular improvements, all of the above). Further understanding of these mechanisms might lead to new CVD treatments.
Although many cardiologists weren’t surprised that GLP-1 users would also have better cardiovascular outcomes, the SELECT trial’s 20% MACE reductions seemed to leave nearly everyone astounded.
Considering that there were 135,000 new semaglutide prescriptions in the United States in May 2023 (without payor coverage or CVD evidence), GLP-1s’ long term population health impact might prove to be more astounding than any of us imagined.