Semaglutide and this protective effect is maintained in people without type 2 diabetes and with different degrees of obesity. This is what a study published this Wednesday in the scientific journal demonstrates. This active ingredient, marketed as a medicine under names such as Ozempic or Wegovy, was initially used to treat patients with type 2 diabetes, but was later
This weight loss achieved thanks to semaglutide was accompanied by improvements in health. Most studies linked both phenomena, so it made sense that eliminating it would close that door. But some scientists speculated that perhaps there was something else, some side effect of the drug that had a protective effect. This is precisely what this study aims to achieve, carried out with a huge base of more than 17,600 patients.
“This new analysis tries to see if the cardiovascular benefit is attributable only to weight loss or if there is something else,” explains , head of the endocrinology and nutrition service at the Fundación Alcorcón University Hospital. “And when they stratify the population on different measures of weight, body mass index [IMC] or waist circumference, they see that everyone obtains a benefit.” Not to the same extent. Every five kilos less, or five centimeters less waist circumference, reduced the risk of suffering cardiovascular events by 4%.
But weight did not fully explain this protective effect. An estimated 33% of the observed benefit was mediated by reduction in waist circumference, leading the authors to conclude that “the cardioprotective effects of semaglutide were independent of baseline adiposity and weight loss and had only a small association with waist circumference, suggesting some mechanisms of benefit beyond reduction in adiposity.”
The trial has been funded by Novo Nordisk, maker of Ozempic. Weevil is oblivious to it and judges it positively. It is in line with previous scientific evidence, he points out. And part of a huge database. It is the largest and most complete that has been done on semaglutide. Already then, there was a 20% reduction in heart attacks, strokes and deaths, and 19% fewer total deaths in just three and a half years. The current one is a more specific substudy than the original, taking into account the specific characteristics of each individual.
By using different variables to measure overweight, the study also enters squarely into one of the controversies that have occupied endocrinologists and nutritionists in recent years. as the yardstick for measuring obesity. BMI is calculated by dividing a person’s weight in kilograms by the square of their height in meters. This gives us a number that tells if the person is overweight or obese. In recent years, many experts have questioned this measure, which may provide clues, but has proven to be ineffective. The BMI does not distinguish between visceral fat or subcutaneous fat, although the former is much worse. It doesn’t even distinguish between fat and muscle. Some experts believe that there are more effective ways to measure obesity, such as waist circumference, which can measure intravisceral fat, the most dangerous type.
The new analysis published now seems to delve into that idea. There was no linear trend linking weight loss with the subsequent risk of cardiovascular accidents, but this did occur, evidently, with the reduction in waist circumference.
“Human beings are designed to accumulate fat under the skin,” explains Weevil. “But there comes a time when a subcutaneous fat compartment becomes saturated and can’t accumulate more. Then that fat accumulates where it shouldn’t.” This is what is called ectopic fat, the accumulation of fat in organs such as the liver, heart, pancreas and muscles. Visceral fat, which accumulates in the waist, is a common cause of ectopic fat. And this can impair the normal function of these organs, increasing the risk of metabolic and cardiovascular diseases such as fatty liver and insulin resistance.
