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Heart month – Could obesity drugs reduce heart disease?

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    February 2024

    For six decades, February has been declared “Heart Month” in the United States and Canada – a month dedicated to raising awareness about heart disease, currently the number one cause of death in Americans and the second leading cause of death for Canadians.1

    A broad term, heart disease generally refers to coronary artery disease and heart attacks. However, any conditions that affect the heart, e.g. congenital heart disease, are also included.

    Risk factors for heart disease include obesity, high blood pressure, high cholesterol, diabetes mellitus, and smoking. Controlling these risk factors can lower the risk of heart disease and subsequent early death. Heart disease can be prevented as well as treated with healthy lifestyle modifications such as diet and exercise.

    But what if these lifestyle modifications aren’t successful?

    In a previous Perspectives article on Obesity, we reviewed new FDA-approved anti-obesity drugs, specifically glucagon-like peptide-1 (GLP-1) agonists, a class of drugs originally approved for the treatment of type 2 diabetes.

    This class of drugs mimics the hormone that stimulates insulin production, which prompts the body to produce more insulin, which lowers blood sugar levels. They also slow the movement of food from the stomach, causing early satiety and decreasing appetite.

    Studies have shown dramatic weight loss effects in both diabetics and non-diabetics compared to other obesity medications. Currently, only two GLP-1 agonists are approved for obesity treatment (see Chart 1), but others, including an oral semaglutide pill, are being actively studied and may soon be more practical options for tackling obesity. 

    GLP-1 agonists FDA approved for weight loss
    semaglutide Wegovy 2.4 mg SQ injection/weekly
    liraglutide Saxenda 3 mg SQ injection/daily

    Can GLP-1 agonists also reduce heart disease risk?

    Previous studies have shown that GLP-1 agonist, semaglutide, reduces adverse cardiovascular risk in patients with type 2 diabetes. This translates into lower rates of cardiovascular death, heart attacks, and strokes in this population2.

    But interestingly, when studying semaglutide on weight loss in the non-diabetic overweight/obese population, additional metabolic benefits, including lower blood pressure, improved cholesterol, and reduced waist circumference – all of which are risk factors for heart disease – were also evident.3

    A study published last fall assessed whether semaglutide could also reduce heart disease risk in people who were overweight or obese but without diabetes. The results were overwhelmingly favorable. In overweight or obese patients [body mass index (BMI) > 27] without diabetes, 2.4 mg of subcutaneous semaglutide injected weekly reduced the incidence of heart disease death, heart attacks, and strokes during the study period of over three years.4

    This is very promising news, as not only can these drugs make a significant impact on the prevalence of obesity, but now there is evidence that they can also decrease heart disease mortality!

    We also must remember that these drugs are not without concerns. They must be given by injection and have potential side effects that include nausea, vomiting, diarrhea, pancreatitis, and kidney and/or liver damage. A study last year reported that 50.3% of adults with type 2 diabetes who were prescribed GLP-1 receptor agonists discontinued the medication within one year. This was higher than any other class of diabetes medication. The authors reported that this high discontinuation rate was most likely due to adverse side effects (mostly gastrointestinal).5

    What will the future hold?

    From a life insurance underwriting perspective, GLP-1 drugs and future combination drugs could not only make a significant impact on worsening rates of obesity, but now we have evidence that the mortality from heart disease can also decrease. This could have a profound impact on mortality projections in the future, given the prominence of heart disease as a leading cause of death in the United States and Canada.    

    As we celebrate American Heart Month, let’s also not forget the benefits of diet and exercise lifestyle modification as significant components of positive heart health. Similar to other weight loss treatments, the most important aspect of weight loss success is a consistent and sustainable healthy lifestyle change! Stay healthy! 

    Contact the Author
    Gina Guzman
    Dr. Gina Guzman
    Vice President & Chief Medical Officer
    Munich Re Life North America

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    References
    1. Heart Disease Facts, cdc.gov, Heart Disease in Canada, canada.ca. 2. Marso, et.al. Semaglutide and Cardiovascular Outcomes in Patients with Type 2 Diabetes. New Engl J Med. 375;19:1834-1844. 3. Rubino D, Abrahamsson N, Davies M, et al. Effect of continued weekly subcutaneous semaglutide vs placebo on weight loss maintenance in adults with overweight or obesity. The STEP 4 randomized clinical trial. JAMA. 2021;325(14):1414-1425. 4. Lincoff AM et, al. Semaglutide and Cardiovascular Outcomes in Obesity without Diabetes. N Engl J Med.  2023 Nov 11. 5 . Liss DT et, al. Treatment Modification After Initiating Second-Line Medication for Type 2 Diabetes. Amer J of Managed Care. Vol 29, No 12; 661-668.