Semaglutide helps heart‑failure patients

Heart failure is the heart’s inability to pump or fill well enough to meet the body’s needs; in a large new analysis, semaglutide cut serious cardiovascular events in patients who already had it. (thelancet.com) The finding came from a prespecified analysis of SELECT, a randomized trial of 17,604 adults age 45 or older with established cardiovascular disease, a body-mass index of 27 or higher, and no diabetes. Patients were assigned weekly semaglutide 2.4 mg or placebo on top of standard care. (nejm.org) In the full SELECT trial, a major adverse cardiovascular event — cardiovascular death, nonfatal heart attack, or nonfatal stroke — occurred in 6.5% of patients on semaglutide and 8.0% on placebo over a mean 39.8 months of follow-up. That was a hazard ratio of 0.80, with the benefit significant at P<0.001. (nejm.org) The heart-failure subgroup included 4,286 people, about 24% of the trial, and the benefit was reported across both reduced ejection fraction and preserved ejection fraction. Ejection fraction is the share of blood the left ventricle pushes out with each beat, a common way doctors sort heart-failure types. (thelancet.com) (acc.org) That matters because obesity and heart failure often overlap, and many older heart-failure drugs were tested without focusing on weight loss medicines. The SELECT population was mostly New York Heart Association class I or II in the heart-failure subgroup, not the sickest class IV patients. (acc.org) Semaglutide is a glucagon-like peptide-1 receptor agonist, a drug class that mimics a gut hormone to reduce appetite, slow stomach emptying, and improve blood-sugar regulation. In March 2024, the U.S. Food and Drug Administration expanded Wegovy’s label to include reducing the risk of cardiovascular death, heart attack, and stroke in adults with cardiovascular disease and overweight or obesity. (fda.gov) (accessdata.fda.gov) The heart-failure result also fits with separate semaglutide data in patients with preserved or mildly reduced ejection fraction, where trials found better symptoms and physical limitations than placebo. Those studies focused on how patients felt and functioned, while SELECT tracked hard cardiovascular outcomes. (thelancet.com 1) (thelancet.com 2) The caveat is that this was a subgroup analysis, not a trial designed only for heart-failure patients, so it can sharpen the picture without settling every question. The main signal is that in overweight or obese adults with prior cardiovascular disease, semaglutide’s cardiovascular benefit did not disappear when heart failure was already part of the case. (thelancet.com)