GLP-1 receptor agonists, including well-known drugs like Ozempic and Wegovy, are demonstrating potential beyond diabetes and weight management, with new research suggesting a significant role in preventing cardiovascular events. A recent study by Dandelion Health indicates that these drugs could prevent up to 34,000 heart attacks and strokes annually in the United States, highlighting a potential paradigm shift in cardiovascular disease prevention.
Expanding the Scope of GLP-1s
Previous clinical trials have primarily focused on the secondary prevention benefits of GLP-1s in high-risk individuals with established cardiovascular disease. However, Dandelion Health's research explored the potential benefits among individuals with mild or moderate CVD who have not experienced a prior heart attack or stroke—a demographic comprising tens of millions of Americans.
Nick Gossen, Head of Growth at Dandelion Health, stated, "What we showed was that patients who initiate treatment with GLP-1s have a lower cardiovascular risk after three years than similar patients who are not taking GLP-1s." The study utilized AI-driven algorithms to analyze real-world data, including electrocardiogram readings and physician notes, to assess treatment efficacy.
Key Findings from Dandelion Health
The research emphasized several key findings:
- GLP-1s could potentially serve as primary prevention for heart attack and stroke for patients with obesity and mild or moderate CVD, representing approximately 44 million additional patients in the US.
- Patients taking GLP-1s experienced a 15-20% reduction in MACE (major adverse cardiovascular events), aligning with clinical trials conducted by Novo Nordisk.
- Predictive AI analysis suggested that patients taking GLP-1s would see a cardiovascular benefit in under two years.
Expert Perspectives and Future Directions
Chad S. Weldy, MD, PhD, a Cardiologist at Stanford Medicine, acknowledges the promise of GLP-1s for CVD prevention. "The past 10 years have now fully established the remarkable benefit of GLP-1 therapies in those overweight and obese individuals with diabetes as well as those without diabetes and established cardiovascular disease," said Weldy.
However, Weldy also cautions that transitioning from secondary to primary prevention with GLP-1s presents challenges due to the difficulty and expense of conducting large-scale clinical trials. A study targeting primary prevention would require tens of thousands of participants and years of follow-up, making it a costly endeavor.
Considerations for Widespread Adoption
While Dandelion's research offers a promising proof of concept, experts emphasize that it is not a substitute for randomized, controlled clinical trials. Furthermore, the potential expansion of GLP-1 prescriptions to millions of Americans raises concerns about cost and the long-term implications for the healthcare system.
Weldy raises a crucial question: "If a large trial is performed for GLP-1 therapy, enrolling anyone who is overweight or obese without known CVD, and…we see a significant reduction in CV events from a primary prevention perspective, a big question would be, 'Who do you not treat with this therapy?'"
Despite these challenges, the potential of GLP-1 drugs to reduce cardiovascular events is significant, warranting further research and careful consideration of their role in primary prevention strategies.
