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Column: Wegovy should be treating more than obesity

Lisa Jarvis, Bloomberg Opinion on

Published in Health & Fitness

A new analysis found that the profound benefits of Novo Nordisk’s obesity drug Wegovy for people at risk of heart attacks or strokes don’t depend on the number of the scale—cardiovascular health improves whether people lose a lot or even very little weight.

That message adds needed nuance to our understanding of the health effects of the new class of medicines known broadly as GLP-1 drugs.

It also raises a critical question: Could these drugs, which also include Eli Lilly & Co.’s Mounjaro, one day shake the “obesity” label and simply be considered heart medications? Or for that matter, metabolic drugs? As data rolls out, kidney care could also make it on the list, and perhaps down the road, brain health.

Much more research is needed, of course. But such a reframing might open the door to better conversations between patients, doctors and insurers, allowing people to put aside their personal biases and dispassionately consider how GLP-1s should be used and paid for.

Because, of course, we’ll never really understand the full health impact of these drugs if insurers won’t pay for them. Access has opened up a bit — a major win came when Medicare agreed to cover Wegovy for people at risk of cardiovascular events — but doctors tell me there are still too many hoops to jump through.

It’s no secret that obesity sits at the intersection of many chronic conditions, yet the perception persists that GLP-1s are a cheat or simply about a desire to be skinny. The reality is different. A recent KFF poll found that 12% of adults in the US have tried a GLP-1 treatment, a number that rises to 25% among people diagnosed with heart disease.

 

“Diabetes, kidney disease and cardiovascular disease is so intertwined with obesity,” says Diana Thiara, medical director of the Weight Management Program at the University of California of San Francisco. Rather than have siloed approaches of treating each disease, it’s better to acknowledge those connections. She tells her patients to focus less on the scale and more on the fact that even a 10% weight loss gives them a 20% less chance of having a heart attack or stroke.

Cardiologists were impressed last fall when a study of more than 17,000 people who had previously had a cardiovascular event (like a heart attack or stroke) found that Wegovy lowered their risk of another event by 20%. That stunning result opened the door to Medicare coverage for the drug in people with heart disease.

This new analysis looks at the same patient population to ask about the weight loss side of the trial. At four years in, the study provided clues about the sustainability of those health benefits—as well as helped answer a lingering question of the source of the heart benefit: Is it due to weight loss alone, or thanks to some other aspect of these drugs?It’s likely a mix of both. The people given Wegovy in the cardiovascular study only lost on average about 10% of their body weight—a result that differs from some of the headline-making numbers in weight loss trials of Wegovy. “There seems to be an effect that transcends the weight-loss benefits,” says James Januzzi, a cardiologist at Harvard Medical School.

Researchers have some hypotheses about what’s driving these heart health benefits. The weight loss surely contributes, but Januzzi thinks it’s possible that where pounds are shed matters more. Reducing belly fat “may be associated with less inflammation and improve cardiovascular outcomes even if the weight loss isn’t that substantial,” he adds. The drugs might also have a direct anti-inflammatory effect, he says, or help to stabilize the heart’s blood vessels so that people are less likely to have a heart attack.

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