A drug to control diabetes could have a positive “side effect”, reportsCorriere della Sera.
Semaglutide has recently been shown to reduce the risk of myocardial infarction, stroke and cardiovascular death in overweight or obese people who already have heart and vascular disease, regardless of the weight loss that can be achieved and which, until now, has been considered to be the real driver of the cardiovascular benefits of the therapy.
This was underlined by research discussed at the last congress of the European Association for the Study of Obesity, which suggests a direct beneficial effect of semaglutide on the cardiovascular system.
The study was conducted on people who were overweight or obese, but without diabetes, but who had already had a heart attack, stroke or peripheral artery disease.
Participants were given semaglutide, a GLP1 agonist used to control blood sugar in people with type 2 diabetes when metformin, the first-choice drug, is insufficient or cannot be used alone, or in those who have diabetes and a cardiovascular risk high because they have already had a heart attack or stroke, for example.
The drug allows substantial weight loss, so it is also prescribed to people with obesity and a body mass index greater than 30 or those with an index greater than 27 and cardiovascular problems, at higher doses than those for the treatment of diabetes.
Previous data from the study had shown that the treatment resulted in considerable weight loss associated with a 20% reduction in cardiovascular risk; the new analysis presented at the EASO congress states that cardiovascular benefits are present regardless of initial weight and especially weight loss, as the risk of events such as heart attacks and strokes decreased in those who lost more than 5% of initial weight, but also to those who did not lose.
John Deanfield of University College London, the lead investigator of the investigation, explained that “weight loss reduces cardiovascular risk, but the data show that, with semaglutide, the magnitude of the effect on the heart and vessels is independent of weight, so there must be different mechanisms that could be due, for example, to the presence of GLP1 receptors on the endothelium lining the arteries or even to a better diet in those treated with the drug.
Luca Busetto, EASO’s Vice-President for Southern Europe, states that “in heart failure, another cardiovascular disease where positive results have been observed with the use of a GLP1 agonist, the benefits appear to be due to the loss of adipose tissue, which makes the work of the heart easier. In contrast, for events such as heart attacks and strokes, there appear to be weight-independent mechanisms that perhaps depend on the presence of GLP1 receptors in many tissues (there are also some in the heart, liver, and brain, no); obesity and cardiovascular disease share a state of chronic low-grade inflammation, so it is possible that the effect also comes from modulating inflammation.
About half of patients who have already had cardiovascular events are overweight or obese, so this is good news for secondary prevention of heart attacks and strokes; In the future, it will be necessary to understand whether other GLP1 agonist drugs that are on the way (from the simplest non-peptide small molecules to the so-called polyagonists that bind to GLP1, but also to other receptors, such as be those for glucagon or GIP, no) will be available or not.
