Wegovy shows CV benefits among SELECT participants regardless of sex
Click Here to Manage Email Alerts
Key takeaways:
- Wegovy was protective of CV events among SELECT trial participants, regardless of sex.
- Women participants experienced greater reductions in weight, waist circumference and high-sensitivity CRP vs. men.
Women with obesity and atherosclerotic CVD without diabetes experience fewer CV events vs. men enrolled in the SELECT trial; however, semaglutide was linked to significant reductions in CV events regardless of sex, a speaker reported.
A post hoc analysis of the SELECT trial evaluating the effects of semaglutide (Wegovy, Novo Nordisk) on CV outcomes by sex was presented at the European Society of Cardiology Congress and simultaneously published in the Journal of the American College of Cardiology.
“Most evidence for sex differences in ASCVD comes from studies that did not specifically evaluate people with overweight or obesity. Importantly, sexual dimorphism exists with respect to the impact of obesity as it related to cardiovascular risk in females vs. males,” Subodh Verma, MD, PhD, cardiac surgeon‐scientist at St. Michael’s Hospital and professor at University of Toronto, said during a presentation. “Whether obesity differentially modulates risk by sex in people with prevalent ASCVD, particularly in the absence of coincident diabetes, remains unknown.
“This is particularly important because anti-obesity therapies, specifically GLP-1 receptor agonists, have shown differential effects on weight by sex and diabetes status,” he said. “Therefore, we performed a post hoc analysis of the SELECT trial to address baseline characteristics and CV risk by sex, and also to evaluate the efficacy of semaglutide 2.4 mg vs. placebo by sex.”
The SELECT trial
SELECT was a randomized trial to evaluate once-weekly semaglutide 2.4 mg compared with placebo for the reduction of secondary major adverse CV events in a cohort of 17,604 adults with CVD and overweight or obesity without diabetes over nearly 40 months of follow-up (28% women).
As Healio previously reported, once-weekly semaglutide 2.4 mg was associated with significantly fewer secondary CVD events in this patient population.
For this post hoc analysis of the SELECT trial, Verma and colleagues evaluated the impact of sex on SELECT outcomes by including a sex-by-treatment interaction term in the trial’s Cox proportional hazards models. Outcomes were evaluated at week 104.
Results of the post hoc analysis
Among participants who received semaglutide, the HR for the primary endpoint — which included death from CV causes and nonfatal MI or stroke — was 0.84 for women (95% CI, 0.66-1.07) and 0.79 for men (95% CI, 0.7-0.9; P for interaction = .63). The results were consistent across all key subgroups.
Within the placebo arm, women experienced a lower incidence rate per 100 patient-years for MACE (1.9 vs. 2.7), all-cause death (2.3 vs. 3.4) and CV death (0.6 vs. 1) compared with men.
Semaglutide was associated with greater reductions in weight (11.1% vs. 7.5%), waist circumference (8.2 cm vs. 5.9 cm) and high-sensitivity C-reactive protein (46% vs. 35%; P for interaction for all < .0001) for women compared with men.
BP, estimated glomerular filtration rate, HbA1c and prevalence of prediabetes were similar between men and women in SELECT, according to the study.
Women in the SELECT trial were older compared with the men (62 years vs. 61 years) and were more likely Black (7.4% vs. 2.4%) with higher BMI (33.5 kg/m2 vs. 31.7 kg/m2), higher LDL (2.3 mmol/L vs. 1.9 mmol/L), higher HDL (1.3 mmol/L vs. 1.1 mmol/L), higher hsCRP levels (2.6 mg/L vs. 1.6 mg/L) and higher urine albumin-to-creatinine ratio (8.3 mg/g vs. 7 mg/g).
In addition, women compared with men were less often previous (34.9% vs. 53.7%) or current smokers (16% vs. 17.1%); were also less likely to receive beta-blockers (63.2% vs. 72.9%) and statins (81.4% vs. 90%); but were more likely to receive diuretics (39.5% vs. 31.2%).
Mean duration of semaglutide exposure and follow-up duration was also similar.
“In SELECT, despite similar age, blood pressure and baseline A1c, but higher baseline LDL, CRP and BMI, females living with overweight or obesity and ASCVD but without diabetes were at a lower risk for MACE compared with males. Baseline history of MI was less frequent and stroke more frequent in females vs. males in SELECT,” Verma said during the presentation. “Semaglutide vs. placebo led to greater reductions in body weight, waist circumference and CRP in females compared with males. The efficacy of semaglutide on cardiovascular, metabolic and kidney endpoints was consistent by sex, regardless of BMI, CRP, [estimated glomerular filtration rate], A1c and prior history of myocardial infarction.
“Of course, the absolute risk reduction for MACE was higher in males vs. females, given the higher placebo event rates,” he said. “Fewer females treated with semaglutide experienced [serious adverse events] leading to treatment discontinuation, although [gastrointestinal] adverse events were similar by sex.”
Reference:
Collapse
Verma S. Clinical trial updates on the GLP-1 receptor agonist, semaglutide. Presented at: European Society of Cardiology Congress; Aug. 30-Sept. 2, 2024; London (hybrid meeting).
Read more about
Click Here to Manage Email Alerts