SELECT study shows similar cardiological benefits of semaglutide in heart failure

Semaglutide (Ozempic, Wegovy; Novo Nordisk) has been shown to be effective in preventing heart attacks and other major adverse cardiac events (MACE) in obese patients with cardiovascular disease (CVD), but the drug's benefits in heart failure (HF) are unknown. In smaller studies, liraglutide (Victoza), another glucagon-like peptide-1 receptor, showed that the drug may cause harm in patients with reduced ejection fraction (HF). In a new analysis of the SELECT trial (NCT03574597), semaglutide showed similar cardiovascular benefits in patients with heart failure.¹

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“Our previous SELECT analysis showed the benefits of semaglutide for people with cardiovascular disease who were obese or overweight. This new study shows that within that group, people with heart failure fared just as well as people without on the outcomes we measured,” said John Deanfield, a professor at the Institute of Cardiovascular Science at University College of London, in a press release. “Our results show that the benefits of semaglutide were similar regardless of the type of heart failure.”¹

Initial results showed that weight loss was sustained over 4 years and that there was a 20 percent reduction in MACE in adults with a body mass index (BMI) over 27 and pre-existing cardiovascular disease.²

“More than 55% of semaglutide patients no longer have an obesity BMI greater than 30. The dataset adds significantly to the semaglutide evidence – the population was 75% male and most weight loss studies have been predominantly conducted in women,” said Dr. Donna Ryan, professor emeritus at Pennington Biomedical Research Center, in an interview.²

The SELECT study enrolled 17,604 people from 41 countries between October 2018 and March 2021. 97.1% of those who received semaglutide and 96.8% of those who received placebo completed the study. About 77% of patients reached the target dose of 2.4 milligrams subcutaneously weekly after 104 weeks and 2 years. There were 569 cardiovascular events in the semaglutide arm compared to 701 events in the placebo arm.²

In the new analysis, published in The Lancetthe researchers found that semaglutide was associated with a reduction in MACE of about 28%, with events occurring in 9.1% of the semaglutide group and 12.3% of the placebo group. In addition, in people with pre-existing heart failure, semaglutide resulted in a 24% reduction in cardiovascular deaths and a 19% reduction in deaths from any cause. In the previous analysis, there were 223 deaths due to cardiovascular events in the semaglutide group and 62 in the placebo group, with Ryan stating that it was not statistically confirmed that semaglutide was associated with a reduction in deaths from cardiovascular causes.^1-3

The researchers compared the effects of semaglutide on preserved and reduced ejection fraction, both of which have different etiologies and treatment responses. The researchers reported that clinical benefit was observed regardless of the type of heart failure and regardless of age, gender, BMI, and clinical status.¹

Treatment discontinuation rates were higher in the HF groups at 14.7% and 9% in the semaglutide group and 9% in the placebo group than in the non-HF groups at 17.2% and 7.9%, respectively. Serious adverse events were reported more frequently in the placebo group, the researchers reported.¹

REFERENCES

1. Weight loss drug's heart benefits extend to people with heart failure. Press release. University College London. August 22, 2024. Retrieved August 22, 2024. https://www.eurekalert.org/news-releases/1055249

2. Gallagher A. SELECT study: Semaglutide improves glycemic control in patients at high risk for cardiovascular disease. Pharmacy opening hours. June 22, 2024. Retrieved August 22, 2024. https://www.pharmacytimes.com/view/select-trial-semaglutide-improves-glycemic-control-for-patients-at-high-risk-of-cardiovascular-disease

3. Deanfield J, Verma S, Scirica BM, Kahn SE, et al. Semaglutide and cardiovascular outcomes in patients with obesity and prevalent heart failure: a prespecified analysis of the SELECT trial. The Lancet. doi: