Questions After Drug Maker Says Wegovy Decreases Risk Of Heart Issues

Novo Nordisk, a Danish pharmaceutical company, recently announced results from a trial that showed that a weight loss drug known as Wegovy reduced the risk of heart attack, stroke and cardiovascular disease by 20%.

The trial enrolled over 17,000 adults aged 45 years or older who were overweight or obese and had established cardiovascular disease but not diabetes. Participants were either given a placebo drug or Wegovy, a once weekly injected FDA approved drug for obesity. According to Novo Nordisk, this trial was the first to demonstrate a class of obesity drugs that could provide long-term benefits for heart disease in those that are overweight and obese.

Given the obesity epidemic in America, these results could have profound public health consequences for Americans in helping to curb rates of heart disease and stroke. According to the National Institute of Diabetes and Digestive and Kidney Disease, more than two in five American adults are obese, which means it is affecting more than 100 million American adults.

Given the potential of this study to change the public health landscape of heart health, here are five questions we all should be asking ourselves about the trial.

How Exactly Does Wegovy Decrease Cardiovascular Outcomes?

Semaglutide, the active ingredient in Wegovy, enhances the effect of the naturally occurring hormone Glucagon-Like-Peptide-1 (GLP-1) which stimulates the release of insulin from the pancreas to decrease blood sugar levels. It also delays the emptying of food from the stomach, enabling patients to feel full for longer periods of time. Finally, the drug acts on hunger centers in the brain to decrease cravings.

How the drug decreases the risk of heart attack, stroke, and cardiovascular disease remains to be elucidated. Possible etiologies include decreasing weight and obesity which in itself is a major risk factor for heart disease. Perhaps the exact mechanism will become clearer when the final details of the trial are released by the drug manufacturer later this year at a medical conference.

Does Wegovy Have The Same Effect On Heart Attacks, Stroke, And Cardiovascular Disease?

Based on Novo Nordisk’s announcement, Wegovy could decrease the overall risk of heart attack, stroke, and cardiovascular disease by 20%. The company stopped short at providing details for each individual outcome. For patients, it would be helpful to know if the drug was more beneficial at mitigating one outcome over another, say heart attack over stroke. Some patients may have a family history of heart disease and would want to know what the exact effect of the drug would be on that outcome versus another outcome.

Will The Results Of The Trial Push Insurers To Cover The Drug?

Medicare and many insurers do not cover weight loss medications, and Wegovy can cost more than $1300 a month according to The New York Times. Given the large health benefit this drug could provide in mitigating the leading cause of death in America, insurers may need to think twice before denying coverage.

Dr. Rekha Kumar, practicing endocrinologist, Chief Medical Officer at weight care program Found and former Medical Director of the American Board of Obesity Medicine, states, “The new trial will force the insurance industry to think more critically about the purpose of anti-obesity medication and to think of it beyond a vanity drug. Insurance companies are going to want to cover it but they’re going to want to also see long term adherence.”

Only time will tell to see if weight loss medications will finally become covered under Medicare and insurance companies.

Will This Trial Perpetuate The Notion Of Medicating Obesity As Oppose To Addressing Its Root Causes?

Obesity is a chronic medical disease that requires a multi-faceted approach that includes not only drug therapy, but also lifestyle changes, diet, exercise and coaching. By providing a drug that not only decreases weight but also decreases one’s risk of heart disease and stroke, it is possible patients may not pay attention to the lifestyle changes such as diet and exercise that are critical to maintaining a healthy lifestyle. A holistic approach is necessary to treat obesity, and this must be emphasized by healthcare workers that are treating patients battling obesity.

How Safe Was The Drug In The Trial?

In general, Wegovy is a safe drug that causes mild side effects such as headache, nausea, vomiting, diarrhea, or constipation. However, in some patients, it can also have more serious side effects such as inflammation of the pancreas, kidney failure, changes in vision in diabetics, and even possible development of thyroid tumors.

However, more details from the trial would be helpful to see how safe the drug was in decreasing the cardiovascular outcomes that were measured. It would be helpful to know how many trial participants had to stop taking the drug or what the incidence of mild and serious side effects were for all participants in the trial. This information could help inform the public on the overall safety of the drug.

Despite these questions, the future of obesity care seems bright.

In an one-on-one interview, Dr. Kumar states, “This trial will really affect the future of obesity care. It will certainly encourage drug development in this field. Drug manufacturers will continue to enhance their products, which will drive prices down and encourage insurers and employers to pick up coverage.”