TOS past presidents comment on SELECT study results

ROCKVILLE, Md.— New findings show that the medication known as Wegovy® (semaglutide) can reduce existing heart disease in patients with obesity by 20%, according to a study co-authored by past presidents of The Obesity Society (TOS) and published in The New England Journal of Medicine.

"The SELECT trial is the first study showing that prescription of an anti-obesity medication in people with overweight or obesity and existing cardiovascular disease can be life-saving,” said co-author and TOS Past President Robert F. Kushner, MD, FTOS, professor, Departments of Medicine and Medical Education, Northwestern University Feinberg School of Medicine, Chicago, Ill.

Kushner added that the impact of this observation was shared by attendees at the opening session of the American Heart Association’s Scientific Sessions, where the results were presented on Nov. 11, 2023, in Philadelphia, Pa.

TOS Past President Caroline M. Apovian, MD, FTOS, served as chair of session discussing the study’s results. She observed that the enthusiasm in the room as the positive cardiovascular reduction results in this cardiovascular outcomes trial of semaglutide in obesity were unveiled “leads us to great hope that cardiologists followed by primary care providers will prescribe glucagon-like peptide-1 receptor agonists and other Nutrient Stimulated Hormone Therapies to all patients with obesity,” she said.

Apovian added “this is the only way to ensure that third-party payors will abandon their short term view of health care cost reduction and pay the costs of these medications to allow 42% of Americans with obesity to live healthier and longer lives.” Apovian is professor at Harvard Medical School and co-director of the Center for Weight Management and Wellness at Brigham and Women’s Hospital, Boston, Mass.

Whether semaglutide can reduce cardiovascular risk associated with overweight and obesity in the absence of diabetes has been unknown. In a multi-center, double-blind, randomized, placebo-controlled, event-driven superiority trial, patients 45-years of age or older with pre-existing cardiovascular disease and a body mass index of 27 or over with no history of diabetes were enrolled in the study.

Patients were randomly assigned in a 1:1 ratio to receive once-weekly subcutaneous semaglutide at a dose of 2.4 mg or placebo. The primary cardiovascular end point was a composite of death from cardiovascular causes, non-fatal myocardial infarction or non-fatal stroke in a time-to-first-event analysis. Safety was also assessed.

Study co-author and TOS Past President Donna Ryan, MD, FTOS, professor emerita of the Pennington Biomedical Research Center in Baton Rouge, La., said, “The overall message was one of consistency—reduction in major adverse cardiovascular events and other hard outcomes as well as benefits for all sub-groups studied.”

She added, “The efficacy profile continued to all the relevant cardiometabolic intermediate end points and the safety profile was reassuring. I felt that the audience had confidence in the results because of the precision with which the study was executed. There were 99% of patients whose status was known at the study’s end. All this good news has been a long time coming—everyone in The Obesity Society community deserves accolades for staying attentive to what obesity really is: a serious chronic disease of excess abnormal body fat. It’s a win, but it is more important than ever that TOS members continue the basic, clinical and population research so needed to conquer this disease.”

Other authors of the study include A. Michael Lincoff, Kirstine Brown‑Frandsen, Helen M. Colhoun, John Deanfield, Scott S. Emerson, Sille Esbjerg, Søren Hardt‑Lindberg, G. Kees Hovingh, Steven E. Kahn, Ildiko Lingvay, Tugce K. Oral, Marie M. Michelsen, Jorge Plutzky and Christoffer W. Tornøe.

To view a copy of the study titled “Semaglutide and Cardiovascular Outcomes in Obesity without Diabetes,” visit The New England Journal of Medicine website.

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The Obesity Society (TOS) is the leading organization of scientists and health professionals devoted to understanding and reversing the epidemic of obesity and its adverse health, economic and societal effects. Combining the perspective of researchers, clinicians, policymakers and patients, TOS promotes innovative research, education and evidence-based clinical care to improve the health and well-being of all people with obesity. For more information, visit www.obesity.org.