A recent meta-analysis has highlighted additional health benefits of the diabetes medication semaglutide, marketed as Ozempic, Wegovy, and Rybelsus, particularly in reducing cardiovascular risk. While only Wegovy has received FDA approval for weight management, the other two formulations are widely used off-label for weight loss.
The analysis revealed significant reductions in various cardiovascular-related outcomes, including a 17% decrease in deaths from cardiovascular disease, a 76% reduction in heart failure hospitalizations, and a 35% decrease in strokes among individuals with diabetes. These findings underscore the potential of semaglutide not only as a diabetes treatment but also as a beneficial agent in managing cardiovascular health.
Despite its weight-loss benefits, the analysis raises questions about the extent to which these cardiovascular improvements can be attributed directly to semaglutide rather than weight loss alone. The study analyzed data from 38 studies involving both diabetic and non-diabetic patients.
In addition to its cardiovascular benefits, the analysis examined gastrointestinal side effects linked to different doses of semaglutide. The 2.4 mg dose was associated with the highest incidence of gastrointestinal issues, particularly with subcutaneous injections. While some adverse effects were noted across various dosages, differences were less pronounced for constipation between oral and subcutaneous forms.
The primary author of the meta-analysis, André Saad, noted the challenge in separating the effects of weight loss from those directly attributable to semaglutide. Cardiologist Jayne Morgan highlighted that semaglutide has known mechanisms that contribute positively to cardiovascular health, such as stabilizing atherosclerotic plaques and improving systemic inflammation related to obesity.
Morgan indicated that the findings from this meta-analysis suggest potential benefits for individuals at risk of cardiovascular disease, even if they do not have diabetes or obesity, thus expanding the relevance of semaglutide beyond its traditional use.
The analysis also found that oral semaglutide was more effective than the subcutaneous version in reducing all-cause mortality. Saad proposed that better adherence and fewer adverse effects from the oral route might contribute to this finding, though he cautioned against drawing definitive conclusions based on limited data.
Adverse effects, particularly gastrointestinal ones, were noted as common reasons for discontinuation of semaglutide, with rates of nausea and vomiting increasing alongside dosage. This emphasizes the need for careful management of side effects to encourage ongoing treatment.
To mitigate gastrointestinal side effects, experts recommend starting patients on the lowest effective dose and gradually increasing it, allowing time for adaptation. Additionally, they advise patients to eat slowly and choose foods that promote weight loss, such as proteins and vegetables, which can also help alleviate symptoms.
In some cases, physicians may prescribe anti-nausea medications to help patients manage side effects. The findings from this meta-analysis position semaglutide as a promising treatment not only for diabetes and weight management but also for improving cardiovascular health.
