Slimming jabs appear to be the gift that keeps on giving. As well as helping people to shed excess weight and control type 2 diabetes, recent research has highlighted that they can have benefits in other areas too — some proved, some still putative — ranging from kidney and liver disease to addiction, osteoarthritis, dementia and cancer. And now they are to be offered to more than a million more people in the UK to protect against heart attack and stroke.
The National Institute for Health and Care Excellence (Nice) has just announced that another 1.2 million people in England could be offered weekly injections of semaglutide (Ozempic/Wegovy) on the NHS to reduce their risk of cardiovascular disease. To be eligible (see below) they must have existing problems such as having had a previous heart attack or stroke, having circulatory problems in their legs and being overweight (a BMI of 27 or more).
The announcement follows the publication of evidence from the international Select trial, which showed that semaglutide offers significant protection over and above preventive medicines such as statins and low-dose aspirin. More than 17,000 overweight volunteers with existing cardiovascular disease, but no diabetes, took part. Half had weekly semaglutide injections added to the regime, while the remainder were given a dummy injection. The difference in outcomes between the two groups was stark.
During the three-year follow-up there were 569 cardiovascular “events” (such as heart attack and stroke) in the volunteers taking semaglutide, compared with 701 in those on placebo. Adding the drug reduced cardiovascular risk by 20 per cent — a similar, but additional protective effect to that offered by statins and low-dose aspirin.
Judging by the comments below the article in The Times the announcement by Nice received a mixed response from readers with some criticising overdependence on medicines as opposed to dealing with underlying diet and lifestyle issues. Or, as one reader put it, “We need to fix the hole in the roof rather than put a bucket under the drip”, while others questioned the NHS’s ability to meet Nice’s recommendations given how slow the rollout of slimming jabs for obesity has been.
I am not here to defend Nice, the NHS or the pharmaceutical industry, but I do think this is an important development and one that is likely to be implemented quickly. Like any sensible doctor, I have always made it clear to my patients that diet and lifestyle modification should be the foundation of preventive measures in cardiovascular disease and medication a supplement to, rather than a substitute for, such change.
However, I am a pragmatist. While having a heart attack or stroke is often a major incentive for people to lose weight and live more healthily, most don’t manage to make the changes required. And, as well as having a huge impact on the individual and their family, the toll exacted by cardiovascular disease affects us all. It takes people out of work and puts NHS and social care resources under even more strain.
It is not just older, retired people who die from or are maimed by a stroke or heart attack. The youngest volunteer in the Select trial was 45 and the average age was 62. These people warrant the best protection we can afford, for both their sakes and society’s.
And the benefits of semaglutide in this context seem to go beyond its impact on weight. Outcomes were similar in those who didn’t lose much weight during the trial (1 in 20 on semaglutide gained weight) and the protective effect became apparent early on, before significant weight loss, suggesting other mechanisms of action. These are thought to include a direct beneficial effect on the delicate lining of arteries, reduced inflammation, lower blood pressure and improvements in lipid profiles (cholesterol tests).
What about access? If you want a slimming jab on the NHS to help you lose weight then don’t hold your breath. Even if you meet the strict criteria you face a long wait. Rollout is proceeding at a snail’s pace and some are predicting that it could take a decade or more for everyone to be offered treatment. The outlook is very different, however, if you are one of the 1.2 million people in England thought to be eligible under this new indication.
A weekly injection of semaglutide will not be automatically added to your regime but it is something you should discuss with your GP or cardiologist at your next appointment if you meet the criteria below. Not everyone will be suitable or can tolerate the drug. Common side-effects include nausea and diarrhoea. The injections can also aggravate underlying gall bladder problems (such as gall stones) and rarely cause pancreatitis, a potentially serious complication.
You can read more about the Select trial at nejm.org.
Nice criteria
Patients will not be automatically prescribed semaglutide. A GP or specialist will assess whether it is the right option based on individual circumstances. To be considered, patients must:
- Have previously had a heart attack or stroke, or be living with peripheral arterial disease (a condition that affects blood flow in the legs),
- Have a body mass index (BMI) of 27kg/m² or above,
- Be willing to make changes to their diet and increase physical activity alongside taking the medication.
If eligible, patients will receive a weekly injection, which they can self-administer at home. The treatment works alongside and not instead of a healthy lifestyle, including a reduced-calorie diet and increased physical activity.
