Semaglutide was once seen mainly as a drug for diabetes, but that perception has clearly shifted in recent years. With consistent evidence showing a reduction in major cardiovascular events, it has started finding a place in routine cardiology practice as well. It is now being discussed not just in endocrinology clinics, but also in cardiac OPDs, especially for patients who have overlapping metabolic and heart-related risks. This naturally brings up a larger question that should it be prescribed to every heart patient? At present, the answer is more selective than universal.
Semaglutide beyond diabetes
According to Dr Vivek Mahajan, Cardiology, Fortis Hospital Kalyan, "Semaglutide influences the GLP-1 receptor system, and it works by more than just regulating blood sugar levels. It also slows down gastric emptying, which means that food stays in stomach longer than normal and one has a prolonged sense of fullness after eating. In addition, semaglutide also has a central effect on appetite regulation within the brain's fullness area it may help reduce hunger and limit the desire to eat. This is especially relevant in patients who struggle with what clinicians often describe as craving-driven eating. Not all hunger is physiological some of it is behavioural. Semaglutide appears to blunt that component effectively."
How semaglutide works?
"The cardiovascular data around semaglutide is one of the main reasons it has gained attention. Large trials of non-diabetic patients such as sustain 6 and the soul trial have shown a reduction in major adverse cardiovascular events. This includes outcomes like heart attacks and strokes. Because of this, semaglutide is now considered as an important option often even a first-line choice in diabetic patients who either already have atherosclerotic cardiovascular disease or are at high risk of developing it," the doctor added.
Strong cardiovascular evidence from major trials
The doctor explains that another important point is the degree of glycaemic control it offers. A reduction in HbA1c of around 2 to 2.5% is substantial and, in many cases, greater than what is achieved with older therapies. Alongside this, patients tend to lose weight. For Indian patients, where diabetes and obesity frequently overlap, this dual effect is particularly useful.
The select trial has demonstrated that treatment of non-diabetic patients with semaglutide leads to a decreased risk of cardiovascular events who are categorised as obese, with a BMI > 30 or > 27. This is particularly valuable to the Indian population as metabolic disease tends to develop at a younger age and at lower BMI in comparison to Western countries.
Who should take semaglutide?
There are also practical considerations, like cost, which is one of the key factors, especially in urban areas where access to advanced treatment options varies widely across patient groups. Some patients may also suffer from gastrointestinal side effects which can affect adherence, especially during the first weeks of therapy.
The introduction of semaglutide is considered as a major step towards linking metabolic health which would eventually improve cardiovascular health. However, the use of semaglutide needs to be guided by clinical considerations rather than one size fits all. Not every patient requires semaglutide but for the right patient, at the right time, in a proper dosage can make a significant difference.
