Breaking news: Semaglutide (“Wegovy”) effectively treats heart failure. Why that is a big, huge, deal.

Brand new high-quality data indicate that semaglutide (the generic name for the blockbuster diabetes and obesity medication Ozempic) is effective in improving symptoms of a certain hard-to-treat type of heart failure. The just-released study—a double-blinded placebo-controlled randomized clinical trial of obese adults—appears in the New England Journal of Medicine.

This research adds evidence to my rapidly-increasing belief that semaglutide-based drugs—the active compound in the touted obesity drugs Ozempic and Wegovy—will turn out to be absolute game-changers for public health.

Heart failure is a condition in which the heart loses efficiency, leading to a chronic mismatch between the body’s need for oxygen and what it actually gets. Heart failure leads to chronic difficulty breathing, uncomfortable swelling in the arms or legs (or anywhere), let alone increased risks for heart attacks, kidney and liver problems, and a slew of other dangerous medical issues. Exploratory findings from this new study (which was carried out in 13 countries in Asia, Europe, and North America) also indicate that patients receiving semaglutide had far fewer serious exacerbations of their heart failure that required an urgent medical visit in which IV medications were needed or a hospital admission was required (1 in 263 for semaglutide versus 1 in 22 in the placebo group). Of interest, the single such event that occurred in the semaglutide recipients happened in the first 8 weeks of the study. After that, zero such events occurred. Meanwhile those events kept accruing at a steady pace throughout the 52-week study. In other words, the effect seemed to be getting larger over time.

As we might expect, the trial participants who received semaglutide lost more weight during the study, as compared to those who received placebo. (This we now take for granted.) In addition, a slew of other potential benefits were found, though for these “secondary” findings, dedicated studies will be needed. For example, patients who received the drug were also found to have better mobility—that is, they could walk noticeably further in a 6-minute walking test.

An important point that some may overlook (and alluded to above): As in other semaglutide studies, the difference between the patients who received the drug and the placebo appeared to be increasing at week 52 (the length of the study). That means the effects over time might be even greater. That’s not a common thing in medical research, and I can’t stress enough how big of a deal that is. It means things may actually end up better than a pharmaceutical-funded study purports, whereas usually, the opposite is true.

This is even bigger than that, though. The reason I’m particularly floored by these results is that, as best anyone can tell, semaglutide has no direct effect on heart tissue. That means that the drug is not directly helping the heart get better. This implies that semaglutide’s other effects on the body are so profound that cardiac complications of obesity and other diseases like diabetes are being literally decimated. The findings therefore even imply that a major form of heart failure is a symptom of another problem altogether. (In case it’s not obvious, that right there is a huge deal; a commentary in the New England Journal came out with this new study specifically to make that point.)

The “real” problem has a name: metabolic syndrome.

Metabolic syndrome itself is a conglomerate of other problems—obesity, high blood pressure, diabetes, elevated bad cholesterol, etc—that collectively cause many of the medical problems we fear: heart attacks and strokes, to say nothing of preventable disability and decreases in quality of life from heart failure.

Semaglutide is already known to be an effective treatment for diabetes and obesity; it even seems to treat high blood pressure. Now we’re seeing that it treats a major form of heart failure—and one for which we don’t have effective treatments?

These drugs are beginning to look like miracle drugs—potentially as big of a game changer as protease inhibitors were in the treatment of HIV/AIDS, when they burst onto the scene in the mid-1990s. Adding protease inhibitors to other antivirals took HIV from being a nearly universally fatal condition to being one that can be better seen as a chronic disease. Sure, metabolic syndromes are not as fatal in the short term as untreated HIV. But in the long-run, metabolic syndromes have incredibly harmful effects on health and, ultimately, on lifespan. They also affect an increasing share of US residents. So while these are very different diseases with distinct patterns, I think the analogy remains apt, nonetheless.

Better, unlike many “potential” miracle drugs that we sometimes get excited about, clinicians have a decade of experience with semaglutide, both before and since the first FDA approval in 2017—a point that my friend and mentor Dr. Harlan Krumholz made to me recently. That means that we don’t have to wonder whether any unexpected surprises—less common but dangerous and statistically important adverse events—are likely to derail things. Often, when drugs go from studies (thousands of patients) to the market (millions of patients), important safety signals emerge that temper our enthusiasm. While we’ve heard of reports of some unusual side effects occurring as semaglutide use has grown, none of them appear common or serious enough to pose a threat to the overall story. These drugs have side effects, yes, and they’re not for everyone. But we know a lot about their overall safety and the outlook is good.

When I first took a close look at these drugs last year, I was impressed. Now, I’m ready to plant a flag: Semaglutide may be the single most important drug researchers can study right now. Our understanding of its ability to reverse the various components of “metabolic syndromes” may eventually lead to massive improvements in health, wellness, and even all-cause mortality, here in the US and elsewhere. It’s expensive (right now), but in the long run, the drug may actually save both lives and money.

It’s not often that we “pass the Rubicon” in the right direction. We may be at just such a moment.

There’s much more to say about this topic, and I’ll follow this story closely in the months and years to come and keep you updated.

What are your questions and comments? Chime in below!