Ozempic: From weight loss wonder drug to breakthrough in heart disease and beyond
Once a diabetes drug, then hailed as a weight-loss miracle, Ozempic and similar drugs such as Wegovy are now being touted as potential game-changers in the fight against a multitude of other diseases and conditions.
As the world grapples with an obesity epidemic and its associated health risks, these drugs are currently offering a glimmer of hope for millions of people worldwide for weight-loss.
However, experts say the drug could have far-reaching effects other than reducing unhealthy body fat, including heart disease, Alzheimer’s disease, sleep apnea – and even alcoholism.
Semaglutide: A breakthrough in cardiovascular health
The largest ever study on the drugs, the SELECT trial, found earlier this month that semaglutide, the key ingredient in Ozempic and Wegovy, was a ‘game-changer’ for heart patients, regardless of weight loss.
In a study of 17,604 adults with diagnosed heart problems who were overweight or obese from 41 countries, researchers found that those who took semaglutide had a 20 percent lower risk of heart attack, stroke, or death from heart disease.
Professor John Deanfield from University College London called it the most significant development in heart disease since the 1990s, saying it “conclusively proves semaglutide is not just an obesity drug as it targets the underlying biology of chronic diseases.”
The findings suggest it could potentially be used to treat a wide range of conditions, from cancer to kidney disease.
Beyond weight loss: Heart health and more
Dr. Sherin Hussain, a Specialist in Internal Medicine at Medeor Hospital in Abu Dhabi, highlighted the broader cardiovascular benefits of semaglutide.
“According to clinical trials, semaglutide significantly reduces the risk of cardiovascular events such as heart attacks or strokes by 20 percent in patients with or without diabetes,” she told Al Arabiya English.
“In people with established heart disease who are overweight or obese, it also reduces the risk of heart failure and provides evidence of kidney protection.”
Semaglutide’s potential anti-inflammatory properties could also benefit heart health, as chronic inflammation is a known risk factor for atherosclerosis and other cardiovascular conditions.
“Ozempic can positively impact heart disease by reducing the risk of cardiovascular events, improving blood pressure and cholesterol levels, promoting weight loss, enhancing glycemic control, and potentially exerting anti-inflammatory effects,” Dr. Hussain added.
Dr Aarti Javeri, Internal Medicine Specialist and Lifestyle Medicine Physician at Sustain Health in the UAE, also said studies have found that drugs containing semaglutide do more than just help with weight loss and blood sugar control.
“These medications not only help with weight loss and its side effects, especially in obesity-related diseases, but they also reduce inflammation,” she told Al Arabiya English.
“Many chronic conditions like type 2 diabetes, certain cancers, obesity, heart disease, and chronic respiratory diseases are caused by ongoing low-level inflammation in the body. These medications reduce this inflammation by directly affecting immune cells, leading to several health benefits.”
Broader health benefits
The benefits of GLP-1 agonists like Ozempic extend beyond heart health and weight loss. “We expect more benefits from GLP-1 agonists, such as weight management, improved liver health, reduced Nonalcoholic steatohepatitis (NASH), slowing the progression of chronic kidney disease in diabetes, and potential benefits for Alzheimer’s disease,” Dr. Hussain explained.
Dr Javeri said some studies have shown the “potential effects of these medications to improve sleep apnea, slow the progression of Parkinson’s and Alzheimer’s disease, improve non-alcoholic fatty liver, and so much more.”
“Most recently, in the New England Journal of Medicine, we’ve seen the results of semaglutide in improving symptoms of heart failure with preserved ejection fraction in patients with obesity (with/without type 2 diabetes)—as well as reducing physical limitations and the need for loop diuretics.”
“That said, we need many more randomized controlled trials and rigorous evidence-based studies to study other end-points of medications, their efficacy and safety, which will happen naturally as more of the population is prescribed them.”
Addressing alcoholism: A future potential
One of the more intriguing potential applications of Ozempic is in the treatment of alcoholism. Studies are ongoing to determine whether semaglutide can be used to treat this kind of addiction in the future.
“Overall, Ozempic reduces appetite and food cravings, which indirectly decreases the desire for alcohol,” Dr. Hussain noted. “Trials have shown that Ozempic may influence the brain’s reward system, particularly dopamine pathways. This could potentially alter craving and reward-seeking behavior, including the consumption of alcohol.”
However, Dr Javeri noted more research is needed before the true benefits of treating such disorders with semaglutide is determined.
“What we know about alcohol use disorder (AUD) is that it’s highly prevalent, highly complex and yet under-treated,” she said. “The treatment for AUD is not a blanket approach and requires a multi-disciplinary team.”
“The role of GLP1-RA like semaglutide has gained traction with regard to treating AUD, but the studies behind this are yet anecdotal and observational. The roles of their use in AUD could be attributed to their ability to slow the transit of food & drink through the intestine leading to a feeling of fullness and potentially a change in absorption of alcohol content blood, along with its ability to cross the blood-brain barrier, modulating the dopaminergic pathways in the brain, and the reward center; thus influencing addictive behaviors.”
Though the data is promising, and randomized control trials are on the way, the robust studies and evidence behind this will be fundamental, especially long-term. We need to understand the impact, efficacy, safety, and drug interactions with these medications in different populations with AUD. With more research in this field, the hope prevails that awareness and education around AUD will increase.”
Ozempic (semaglutide) works via its key ingredient: GLP-1 (Glucagon-like-peptide 1). GLP-1 is a natural peptide that is produced by the L-cells in the small intestine in response to food.
Dr Javeri explained that GLP-1 has a very short half-life (only a few minutes long), as it’s degraded by an enzyme called DPP-IV.
“So, in a normal scenario, the body’s innate GLP-1 will not cross the blood-brain barrier and will not stay “active” for long at all,” she said. ”Semaglutide acts as an “analog” or “mimic” to GLP-1 in the body and connects with the receptors to increase the various actions of it in the body over a long period of time. It reduces gastric emptying (slowing down the transit of food in the intestine), crosses the blood-brain barrier and works on appetite & reward centers in the brain to reduce appetite, induces insulin secretion from the pancreas, modules blood glucose levels, reduces inflammation, alters cardiac contractibility and so much more.”
Rise in popularity
Despite their potential for other health benefits, Ozempic, Wegovy, and other semaglutide-containing drugs remain highly popular due to their ability to aid rapid and significant weight loss.
The hashtag #Ozempic has more than 1.2 billion views on TikTok. It’s so effective at helping people lose weight that supplies of the active ingredient, semaglutide, have run short in countries including Britain and the United States.
Use ‘should be monitored.’
However, the rapid rise in the popularity of these drugs has not been without controversy.
Dr. Sarah Alam, a Specialist Endocrinologist at the Canadian Specialist Hospital Dubai, emphasized the need for cautious and monitored use.
“Recent advancements in anti-obesity medications, such as Ozempic and Wegovy, have significantly transformed the landscape of obesity treatment and help individuals achieve more significant and long-lasting weight loss,” she said.
“Despite their potential, many social media campaigns criticize these medications, portraying their use as a ‘shortcut’ or easy solution.”
Dr Javeri agrees.
“It’s important to note that most studies have been conducted for specific disease-requiring conditions as opposed to people who want to “shed” those last few pounds,” she said. “In the case of the latter, it’s important to remove the urge for a “quick fix” and focus on the root cause of those last few pounds; body image, addressing disordered eating patterns or eating disorders, exploring the patient’s relationship with food and so on.”
“For all my patients – whether on or off Ozempic, I stress the importance of improving their relationship with food, developing a positive body image and instilling lifestyle behaviors (addressing nutrition, movement, sleep, stress management and connection) that really stick long term. We need to start educating patients about this because that’s where you really get a bang for your buck and improve longevity, mortality and morbidity.”
The Novo Nordisk Effect: Transforming Denmark’s economy
The global phenomenon of Ozempic and Wegovy has not only transformed the lives of patients but also the fortunes of their maker, Novo Nordisk. The Danish company is now Europe’s most valuable, with a market capitalization larger than the Danish economy itself.
Novo’s success has had profound implications for Denmark. Its income tax bill last year was $2.3 billion, and its investments and heightened production helped the domestic economy expand almost 2 percent — more than four times the EU average. Without Novo’s contribution, the Danish economy would have stagnated.
The company’s influence is felt across the country, from educational and research priorities to immigration policy and infrastructure development. Danish pension funds are flush from record returns on Novo shares, and mortgages are cheaper as booming diabetes drug exports have forced Denmark’s central bank to keep interest rates low.
It has also spawned a race from other drug makers to produce other alternatives.
In a media roundtable held in the UAE this week, Novo Nordisk CEO Lars Fruergaard Jorgensen emphasized the company’s long-term vision and the expected increase in competition within the major disease areas they serve. “We have to expect that with the big disease areas we are serving, that there will be increasing competition,” he said.
Despite this, he remains optimistic about the future: “It is an exciting future of getting to treat many more patients with advancing science, but also addressing more competition in quite attractive market opportunities.”
Dr Javeri said that as more drug makers enter the market and more clinical trials take place, the world could see more ‘refined’ versions of the drugs, which could have fewer of the side effects that some patients have experienced, including nausea and heartburn.
“Unsurprisingly, the global obesity drug market is expected to skyrocket; newer drugs are going through clinical trials, more patient-facing clinical trials, and so much more,” she said.
“In my practice, I usually find that the side effects of Ozempic are tolerable if prescribed correctly. The biggest side effects we see when the dosages are changed too soon is that the patient hasn’t been given enough advice regarding lifestyle (strength training, adequate protein and fiber intake, etc) and the support provided whilst using the medication is poor.”
“However, advancements in lifestyle medicine and precision prevention are enabling us to take a more personalized approach to managing these medications. We can better tailor treatments based on a patient’s genetic makeup, helping to predict how they will respond to the drugs. It’s essential for both doctors and patients to consider appropriate administration & dosing, but also various lifestyle factors, such as exercise, proper nutrition, and ongoing support, to maximize the medication’s effectiveness and minimize side effects.”
Global health challenges
As the world faces a clear shift in global health challenges, with obesity, high blood sugar, and high blood pressure leading to more years of healthy life lost, drugs like Ozempic and Wegovy are becoming increasingly crucial.
Dr Alam emphasized the need for a multi-pronged approach to obesity treatment: “Obesity is a chronic disease with a multifactorial aetiology and is associated with increased morbidity and mortality. Obesity needs multi-pronged treatment strategies.”
Despite their potential, Dr. Alam cautioned against the misuse of these medications: “Of course, there are clear indications for medications like Ozempic or Wegovy, and they should not be self-prescribed or bought over the counter.
They require close monitoring and follow-up under the guidance of medical professionals.”
As more data emerges, the medical community remains optimistic about the additional benefits these medications offer in reducing cardiovascular risk and tackling other chronic diseases. The development of semaglutide has not only opened up a new market for weight loss drugs but also offers hope for millions of people worldwide struggling with obesity and its associated health risks – and other diseases.
As Professor Deanfield put it, “We now have a class of drugs that could equally transform many chronic diseases of ageing.”
