Cristóbal Morales
Head of the Metabolic Health, Diabetes and Obesity Unit at Vithas Hospital in Seville and member of the Spanish Society for the Study of Obesity (SEEDO)
The SELECT trial provided the first evidence of the benefit of 2.4 mg semaglutide in overweight and obese people without diabetes, showing a reduction of more than 20 per cent in cardiovascular events. This was not surprising, as numerous studies in type 2 diabetes had already demonstrated the benefits of GLP-1, but this was the first large-scale study, involving over 17,000 patients followed for four years, in which Spain played a very active role. Here, in the absence of diabetes, a reduction in these events has been achieved for the first time.
It is a high-quality study because it involves a large number of patients over a very long period, and, naturally, data continue to be published; in this case, the findings are truly interesting. We are already aware of the beneficial effects it has on risk factors such as weight, waist circumference, inflammation, glycated haemoglobin levels, systolic blood pressure and renal function. However, all these improved variables would only account for 31 per cent of this cardiovascular benefit.
There remains a statistically significant proportion—69 per cent—of this cardiovascular benefit that requires further investigation. It is hypothesised that this may be due to the direct anti-inflammatory effect of GLP-1, improvements in vascular health and, naturally, renal and lipid protection.
We now know, thanks to major studies such as SELECT, that the benefit of this new class of drugs goes far beyond weight loss or waist circumference reduction. It has a proven cardiovascular benefit, with a 20 per cent reduction in events. For many reasons, we must stop thinking of it as a drug for losing weight; it is a drug for gaining health and, indeed, cardiovascular health.