Episode 140: Wegovy and Heart Disease

[00:00:00] [SPEAKER_00]: Welcome back to the Back on Track Achieving Healthy Weight Loss, where I help you get on

[00:00:05] [SPEAKER_00]: track and stay on track with your weight loss journey.

[00:00:09] [SPEAKER_00]: I'm your host, Dr. Alicia Shelly, so let's get started.

[00:00:27] [SPEAKER_00]: Hello, and welcome to the Back on Track Achieving Healthy Weight Loss podcast.

[00:00:33] [SPEAKER_00]: I'm your host, Dr. Alicia Shelly.

[00:00:35] [SPEAKER_00]: Now, this week, the FDA has approved Wegovy to be indicated to reduce the risk of heart

[00:00:44] [SPEAKER_00]: attacks, strokes, and other cardiovascular problems in adults with heart disease who are overweight

[00:00:51] [SPEAKER_00]: or who have obesity.

[00:00:53] [SPEAKER_00]: This is huge!

[00:00:55] [SPEAKER_00]: I mean, you may be thinking, what?

[00:00:58] [SPEAKER_00]: Is it Wegovy or Weight Loss medication?

[00:01:01] [SPEAKER_00]: And how does this happen?

[00:01:04] [SPEAKER_00]: Well, today we are going to discuss it all.

[00:01:07] [SPEAKER_00]: Now, last year in 2023, there was a release of the Select trial.

[00:01:13] [SPEAKER_00]: In the Select trial, it goes into more detail on how Wegovy has been shown to reduce the

[00:01:21] [SPEAKER_00]: risk of heart disease, heart attacks, strokes, and cardiovascular problems in adults who already

[00:01:27] [SPEAKER_00]: have heart disease.

[00:01:28] [SPEAKER_00]: And so, the Select trial is an international study that took around 17,604 adults from all

[00:01:37] [SPEAKER_00]: over the world, ages 45 and older with a body mass index of at least 27 and above, and the

[00:01:44] [SPEAKER_00]: history of heart disease.

[00:01:46] [SPEAKER_00]: Now, the one thing that's important here is that these participants did not have

[00:01:51] [SPEAKER_00]: diabetes, so they were excluded from the trial.

[00:01:53] [SPEAKER_00]: And the reason is that with diabetes, it increases your risk for heart disease.

[00:01:58] [SPEAKER_00]: So they wanted to kind of see what was that risk of heart disease in people who just had

[00:02:04] [SPEAKER_00]: heart disease.

[00:02:05] [SPEAKER_00]: Now, they gave half of the group, semi-glutine, 2.4 milligrams, and the other half they gave

[00:02:11] [SPEAKER_00]: placebo.

[00:02:12] [SPEAKER_00]: And they followed them up for approximately 39 months or about a little over three

[00:02:16] [SPEAKER_00]: years and they looked to see the primary outcome, which is did they experience death

[00:02:22] [SPEAKER_00]: from cardiovascular disease?

[00:02:24] [SPEAKER_00]: Did they have another or an additional non-fatal myocardial infarction, which is another word

[00:02:30] [SPEAKER_00]: for heart attack?

[00:02:32] [SPEAKER_00]: Or did they have a non-fatal stroke?

[00:02:35] [SPEAKER_00]: And what they found was that in comparison to placebo, that would go be reduce the

[00:02:41] [SPEAKER_00]: risk of a heart attack, stroke, and heart related death by 20%, 20%, which is amazing.

[00:02:50] [SPEAKER_00]: Because if you've already had a heart attack, the last thing you want to do is have another

[00:02:54] [SPEAKER_00]: heart attack or have a stroke or have some other cardiovascular problem.

[00:02:58] [SPEAKER_00]: You want to be able to, first of all, after that first heart attack, you want to just

[00:03:03] [SPEAKER_00]: kind of keep it level, keep your heart fine without having any further problem.

[00:03:08] [SPEAKER_00]: And so Wagovic can help with that.

[00:03:11] [SPEAKER_00]: Now let's look at how Wagovic helps with improvement of your cardiovascular disease.

[00:03:17] [SPEAKER_00]: And I will say it's not 100% completely known exactly what happens, but scientists

[00:03:23] [SPEAKER_00]: believe they have some theory on what does happen.

[00:03:26] [SPEAKER_00]: The first thing is that Wagovic works at the receptor called GLP1.

[00:03:31] [SPEAKER_00]: This receptor can be found in your stomach or your gut and your brain

[00:03:35] [SPEAKER_00]: and your pantries throughout the GI tract.

[00:03:38] [SPEAKER_00]: And what it does, it helps with slowing down the gastric motility.

[00:03:43] [SPEAKER_00]: So kind of slowing down your gut, which reduces your appetite

[00:03:46] [SPEAKER_00]: and makes it a little bit easier to not, you don't take in as many calories

[00:03:50] [SPEAKER_00]: because of that, which in turn reduces the abnormal body fat that's being stored

[00:03:56] [SPEAKER_00]: underneath our skin and our organs that can contribute to more atherosclerosis

[00:04:02] [SPEAKER_00]: or the plaque buildup in our blood vessels and heart dysfunction.

[00:04:06] [SPEAKER_00]: Now what's been known about the medications in this class, the GLP1

[00:04:10] [SPEAKER_00]: class is that they do reduce inflammation in the body.

[00:04:13] [SPEAKER_00]: They improve left ventricular heart function.

[00:04:16] [SPEAKER_00]: And they promote that plaque stability that you see in the blood vessels.

[00:04:20] [SPEAKER_00]: Now, when they looked at the study, the select trial,

[00:04:25] [SPEAKER_00]: they noted that there were other multiple biomarkers that had improved,

[00:04:29] [SPEAKER_00]: such as they improved the blood pressure, they improved the waist circumference.

[00:04:34] [SPEAKER_00]: And the reason why we look at waist circumference is that

[00:04:36] [SPEAKER_00]: the fat that's being stored in our stomach actually puts us at increased

[00:04:40] [SPEAKER_00]: risk for cardiovascular disease.

[00:04:42] [SPEAKER_00]: So the fact that that's improving is important.

[00:04:44] [SPEAKER_00]: Also glycemic control.

[00:04:46] [SPEAKER_00]: I mentioned before in the study, they did not look at people who had diabetes.

[00:04:50] [SPEAKER_00]: The reason being is that with diabetes, that sugar, the extra sugar

[00:04:53] [SPEAKER_00]: that's in the blood actually can cause more issues or can cause more damage

[00:04:59] [SPEAKER_00]: to the blood vessels and can put somebody at a two to four times

[00:05:03] [SPEAKER_00]: increased risk for a heart attack and stroke in comparison to

[00:05:07] [SPEAKER_00]: somebody who does not have diabetes.

[00:05:09] [SPEAKER_00]: So the fact that the regoli reduces the sugar levels is extremely important.

[00:05:14] [SPEAKER_00]: Also in this study, it was noted that the kidney function had improved as well

[00:05:20] [SPEAKER_00]: and that the levels of your cholesterol and C-reactive protein has improved.

[00:05:25] [SPEAKER_00]: And when we compare this to the study that talked about how statins

[00:05:30] [SPEAKER_00]: or the cholesterol medication improved heart disease, it was very similar,

[00:05:35] [SPEAKER_00]: which means that this is just another tool for the toolbox

[00:05:37] [SPEAKER_00]: to help other people who have heart disease not get another problem,

[00:05:43] [SPEAKER_00]: heart problem.

[00:05:44] [SPEAKER_00]: Now, the other thing I want to say is that in this study, they didn't lose

[00:05:49] [SPEAKER_00]: as much weight as they had in prior studies.

[00:05:51] [SPEAKER_00]: In fact, the average weight loss was 9.4%.

[00:05:55] [SPEAKER_00]: And then the initial study, Wagobi's trial, they lost around close to 15%.

[00:06:02] [SPEAKER_00]: And with this study, they didn't really focus on lifestyle changes.

[00:06:06] [SPEAKER_00]: So that may be why you see that decrease in body weight.

[00:06:10] [SPEAKER_00]: And there's not the same in prior studies.

[00:06:13] [SPEAKER_00]: And so with that being said, this study that showed that Wagobi reduced

[00:06:18] [SPEAKER_00]: the risk by 20% is the reason why the FDA has placed that as an indication

[00:06:24] [SPEAKER_00]: on their medication that it can be used for people who have a history

[00:06:28] [SPEAKER_00]: of heart disease and who are overweight and obesity.

[00:06:32] [SPEAKER_00]: It will help with reduction of having another heart attack

[00:06:35] [SPEAKER_00]: or stroke or cardiovascular problem.

[00:06:37] [SPEAKER_00]: I know I get a lot of questions from my colleagues and from my patients.

[00:06:41] [SPEAKER_00]: Is this medication safe for my heart?

[00:06:44] [SPEAKER_00]: Well, the one good thing that with this trial is that it shows

[00:06:47] [SPEAKER_00]: that there is safety data out there that it can help improve your heart

[00:06:51] [SPEAKER_00]: and reduce your risk.

[00:06:53] [SPEAKER_00]: So I hope that kind of gives people some pause.

[00:06:56] [SPEAKER_00]: And if you're thinking, is this medication the right fit for me?

[00:07:00] [SPEAKER_00]: Well, I think it's time for you to make that appointment

[00:07:02] [SPEAKER_00]: with your doctor for you all to talk about it and to make sure

[00:07:05] [SPEAKER_00]: that you are the right candidate.

[00:07:06] [SPEAKER_00]: Now, the one thing that was seen in this study was that there were

[00:07:10] [SPEAKER_00]: adverse reactions.

[00:07:11] [SPEAKER_00]: The GI side effects were there and around 16% of people

[00:07:15] [SPEAKER_00]: in that semi-glutide arm did stop the medication

[00:07:19] [SPEAKER_00]: because of the GI side effects.

[00:07:21] [SPEAKER_00]: So not everyone can take this medication and you don't know

[00:07:24] [SPEAKER_00]: until you take it with how your body will respond.

[00:07:27] [SPEAKER_00]: But for all those that are able to take it, definitely speak

[00:07:31] [SPEAKER_00]: to your doctor about it, about whether this would be a good fit.

[00:07:34] [SPEAKER_00]: And hopefully once the back orders and the insurance challenges

[00:07:38] [SPEAKER_00]: improve, it won't be a problem for people to get access

[00:07:41] [SPEAKER_00]: to this medication because at the time of this recording,

[00:07:44] [SPEAKER_00]: it is on back order and it makes it a little bit difficult

[00:07:47] [SPEAKER_00]: for people to get started.

[00:07:48] [SPEAKER_00]: But hopefully soon in the future, it'll be a little bit easier.

[00:07:52] [SPEAKER_00]: Now, I thank you so much for joining me today as we talk

[00:07:56] [SPEAKER_00]: about this groundbreaking indication for Wagobi.

[00:08:00] [SPEAKER_00]: Know that there is a lot of medications out there.

[00:08:02] [SPEAKER_00]: There's a lot of information out there.

[00:08:04] [SPEAKER_00]: And so it's definitely important that you see your doctor

[00:08:07] [SPEAKER_00]: and you all discuss what your options are and how you can live

[00:08:10] [SPEAKER_00]: a more healthier life.

[00:08:12] [SPEAKER_00]: And again, if you like this episode, please feel free to share

[00:08:16] [SPEAKER_00]: it with others, like it and subscribe.

[00:08:18] [SPEAKER_00]: And don't forget to give us a five star review.

[00:08:21] [SPEAKER_00]: This will help us to attract other people who are trying

[00:08:24] [SPEAKER_00]: to also lose weight in a healthy manner.

[00:08:27] [SPEAKER_00]: I hope you have a fabulous rest of your day

[00:08:29] [SPEAKER_00]: and thank you again for tuning in to the Back on Track

[00:08:33] [SPEAKER_00]: Achieving Healthy Weight Loss Podcast.

[00:08:35] [SPEAKER_00]: And we'll see you all next time.