Semaglutide, a medication used in drugs like Ozempic, Wegovy, and Rybelsus for treating diabetes and obesity, is associated with a significant reduction in cardiovascular risk, according to a recent meta-analysis published in the International Journal of Obesity. The study, encompassing 38 trials, suggests that the benefits of semaglutide extend beyond weight loss, directly impacting heart health.
The meta-analysis, led by André Saad from the State University of Ponta Grossa in Paraná, Brazil, examined data from individuals with and without diabetes to evaluate the cardiovascular effects of semaglutide. The findings indicate that semaglutide not only aids in weight management but also stabilizes atherosclerotic plaques and reduces systemic inflammation, both critical factors in preventing acute myocardial infarction.
Jayne Morgan, a cardiologist at Piedmont Healthcare Corporation, who was not involved in the study, highlighted that semaglutides act directly on blood vessels, improving blood flow to the heart and lowering blood pressure. She also noted the positive effects on kidney function, liver steatosis, cholesterol profiles, and the central nervous system. Morgan stated, "There appears to be great promise for this entire class of GLP1-RA drugs, and semaglutides in particular. They currently appear to be best in class for cardiovascular risk reduction and HFpEF reduction in hospitalizations, with a 35% reduction in the risk of stroke in those with type 2 diabetes."
Dosage and Adverse Effects
The meta-analysis also investigated the impact of semaglutide dosage on gastrointestinal adverse effects. Results showed that individuals receiving a 2.4 mg dose of semaglutide reported the highest incidence of gastrointestinal issues, such as stomach pain, nausea, constipation, and diarrhea. Subcutaneous administration of semaglutide was generally associated with a higher frequency of these side effects compared to the oral formulation.
Notably, 9% to 11% of subcutaneous semaglutide users discontinued treatment due to adverse effects. In contrast, oral semaglutide demonstrated a reduction in all-cause mortality compared to the subcutaneous version. Saad hypothesized that better adherence and fewer adverse effects associated with the oral route contributed to this outcome, though he cautioned that more research is needed to confirm these findings.
Managing Gastrointestinal Side Effects
Mir Ali, a bariatric surgeon at MemorialCare Surgical Weight Loss Center, suggested strategies for minimizing gastrointestinal side effects, including starting patients on the lowest possible dose and adjusting it gradually. He emphasized the importance of eating slowly while taking semaglutide, as the medication affects stomach emptying. Ali also recommended reducing carbohydrate intake and focusing on protein and vegetables to facilitate weight loss and minimize symptoms. In severe cases, anti-nausea medication may be prescribed.
Implications for Obesity Treatment
Saad emphasized the importance of viewing obesity treatment as an ongoing process, similar to managing other chronic conditions like diabetes and hypertension. He noted that early cessation of treatment could lead to weight regain and that treatment plans should be individualized to each patient's needs.
