At the American College of Cardiology’s 74th Annual Scientific Session in Chicago, results were released from a study by Lincoff et al., investigating the effect of glucagon-like peptide-1 receptor agonist (GLP-1RA) semaglutide on the total cardiovascular (CV) events in patients with CV disease (CVD) who are either overweight or obese, but who did not have diabetes.
Semaglutide was found to reduce the occurrence of major adverse cardiovascular events (MACE) by 20% in patients with a history of CVD and who were overweight or obese without diabetes. However, these patients were still found to be at risk for subsequent ischemic events. There is an increasing demand for GLP-1RAs across the spectrum of CVD. Given the increased risk of MACE presenting in patients alongside obesity, the demand to measure CV outcomes with these therapies, based on their track record of significantly positive results, remains potent.
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This study was a prespecified secondary analysis of the SELECT trial, which was designed to determine the effect of semaglutide on total CV events in patients without diabetes aged ≥45 years with CVD and a body mass index ≥27 kg/m2. Patients were randomised 1:1 to weekly subcutaneous semaglutide 2.4mg or placebo. The outcome was total (first and subsequent) events of an expanded MACE-5 (CV death, non-fatal myocardial infarction (MI), non-fatal stroke, coronary revascularisation, or hospitalisation for unstable angina). Among the 17,604 patients followed for a mean of 39.8 months, 1,947 (64%) endpoint events and 1,084 (36%) subsequent events occurred. Coronary revascularisation represented 27.2% of first events and 72.9% of subsequent events; non-fatal MI was 26.2% of first events and 10.3% of subsequent events. Semaglutide was able to reduce first MACE-5 events (hazard ratio 0.80; 95% CI 0.73-0.87; P<0.001) and total MACE-5 events (mean ratio [MR] 0.78; 95% CI 0.70-0.86; P<0.001). A reduction in total events was driven by fewer non-fatal MIs (MR 0.69; 95% CI 0.58-0.82; P<0.001) and coronary revascularisations (MR 0.74; 95% CI 0.65-0.84; P<0.001).
The study concluded that semaglutide reduces the burden of first and total CV events in patients with CVD and obesity or overweight. GD predicts a continued increase in the prescribing of semaglutide in the CV disease space. Clinical data demonstrates that semaglutide is able to address the cardiometabolic syndrome as a whole, and it is likely Novo Nordisk`s share of the GLP-1 market will continue to increase steadily as a result. The data from this study demonstrating the reduced MACE risk from administering semaglutide is reflective of physicians’ ongoing real-world experience of prescribing this therapy for patients with T2D and/or obesity with CV disease.
