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Semaglutide decreases cardiovascular risk score after one year of use

Two new studies presented at this year's European Congress on Obesity have revealed that semaglutide is effective for weight loss in a multi-centre one year-long real-world study and decreases cardiovascular risk score after one year of use.

In the studies by Drs Andres Acosta and Wissam Ghusn, from the Precision Medicine for Obesity Program at the Mayo Clinic, Rochester, MN, and colleagues, they performed a retrospective, multi-centre (Mayo Clinic Hospitals: Minnesota, Arizona, and Florida) data collection on the use of semaglutide for the treatment of obesity. They included patients with a body mass index (BMI) ≥27 kg/m2 (overweight and all higher BMI categories) who were prescribed weekly semaglutide subcutaneous injections (doses 0.25, 0.5, 1, 1.7, 2, 2.4mg; however most were on the higher dose 2.4mg). They excluded patients taking other medications for obesity, those with a history of obesity surgery, those with cancer, and those who were pregnant.

The primary end point was total body weight loss percentage (TBWL%) at one year. Secondary end points included proportion of patients achieving ≥5%, ≥10%, ≥15%, and ≥20% TBWL%, change in metabolic and cardiovascular parameters (blood pressure, HbA1c, fasting glucose and blood fats), TBWL% of patients with and without T2DM, and frequency of side effects during the first year of therapy.

A total of 305 patients were included in the analysis (73% female, mean age 49 years, 92% white, mean BMI 41, 26% with T2DM). In the entire cohort, the mean TBWL% was 13.4% at one year (for the 110 patients who had weight data at one year). Patients with T2DM had a lower TBWL% of 10.1% for the 45 of 110 patients with data at one year, compared to those without T2DM of 16.7% for the 65 of 110 patients with data at one year.

The percentage of patients that lost more than 5% of their body weight was 82%, more than 10% was 65%, more than 15% was 41%, and more than 20% was 21% at one year. Semaglutide treatment also significantly decreased systolic and diastolic blood pressure by 6.8/2.5 mmHg; total cholesterol by 10.2 mg/dL; LDL of 5.1 mg/dL; and triglycerides of 17.6 mg/dL.

Half of the patients experienced side effects related to the medication use (154/305) with the most reported being nausea (38%) and diarrhoea (9%). The side effects were mostly mild not affecting the quality of life but in 16 cases they resulted in stopping the medication.

"Semaglutide was associated significant weight loss and metabolic parameters improvement at one year in a multi-site real-world study, demonstrating its effectiveness in the treatment of obesity, in patients with and without T2DM," they summarised.

The second study found that patient’s cardiovascular risk score improved after one year of semaglutide use in patients with overweight and obesity.

The multi-centre retrospective study of 93 patients with a BMI 27kg/m2 or higher, age between 40-79 years, and no prior history of CVD. They collected baseline demographic, clinical, and blood fat data to calculate the ten-year atherosclerotic cardiovascular disease (10-year ASCVD estimator created by the American College of Cardiology) risk at baseline (i.e., before starting semaglutide) and one year after semaglutide initiation.

The primary end point included calculating the difference in ASCVD score between baseline and after one year of starting semaglutide. Secondary outcomes included metabolic parameters and medication use.

Of the 93 participants, 69% were female, and the mean age was 55 years. Almost all (91%) were White. The mean BMI was 39.8kg/m2, on the borderline between class II and class III obesity.

There was a significant decrease in the 10-year ASCVD risk between baseline and one year: 7.64% vs. 6.26%, a drop of 1.38%. The following parameters decreased significantly: blood pressure by 9.3/4.9mmHg (for systolic and diastolic), total cholesterol by 9.5mg/dL; LDL by 6.6mg/dL, triglycerides by 20.0mg/dL, fasting glucose by 23.0mg/dL, and HbA1c by 0.72%.

There was no significant change in use of blood pressure medications, statins, or aspirin between baseline and last follow-up. The total % body weight loss associated with semaglutide use at 12 months was 10.9% (across 41 patients for whom weight data was available at 12 months).

"Use of semaglutide in patients with overweight or obesity is associated with a decrease in the 10-year ASCVD risk. Although modest after just one year of use, this decrease may translate into decreased cardiovascular morbidity and mortality risk over time with continuing weight loss,” the authors concluded. “More studies, with larger sample sizes and longer follow-up periods, are needed to assess the cardiovascular outcomes of semaglutide."

The authors are considering carrying out longer term studies to see if the effect of semaglutide on cardiovascular risk extends/changes over time. In addition, the Mayo team are preparing several other papers relating to semaglutide, including weight outcomes in patients who had weight recurrence after bariatric surgery and weight loss outcomes in patients who were on other anti-obesity medications previously vs to those who were not.


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