Could Semaglutide Change That?
By Jamie Bussin
Heart disease remains one of the most significant health threats in Canada today. According to the Canadian Chronic Disease Surveillance System, heart disease is the second leading cause of death in this country, affecting an estimated 2.6 million adults — that’s roughly 1 in every 12 Canadians.
Even more alarming, 14 Canadians die from heart disease every hour. While men are statistically twice as likely as women to suffer a heart attack, the risks for women, especially after menopause, are nearly as concerning. Fortunately, a wave of groundbreaking research is giving renewed hope to both physicians and patients alike.
On Episode #347 of the Tonic Talk Show/Podcast Dr. Subodh Verma, a leading cardiac surgeon and scientist from St. Michael’s Hospital in Toronto, recounted these developments in greater depth. Together, they dissected the causes of heart disease, the disparity in how it affects different populations, and the emerging therapies that could redefine treatment protocols. This is a digest of that discussion.
What Is Heart Disease and Why Does It Happen?
At its core, heart disease is largely caused by the buildup of plaque in the arteries (like rust in the pipes); a condition known as atherosclerosis. This buildup disrupts the flow of blood to key organs. When it occurs in the heart, it leads to a heart attack; in the brain, a stroke; and in the legs, it causes peripheral arterial disease (PAD). These are all forms of cardiovascular disease and can have devastating consequences if not properly managed.
According to Dr. Verma, the origins of heart disease are multifactorial. It’s a combination of genetic, non-modifiable traits and lifestyle choices. The risk factors that we can’t change include age, sex, race, and inherited traits such as familial hypercholesterolemia (genetically high cholesterol). But there are modifiable risk factors too—ones that individuals have the power to influence. These include blood pressure control, weight management, cholesterol levels, smoking cessation, physical activity, and diabetes management.
Gender and Ethnicity: Disparities in Risk
Statistically, men are at a higher risk of developing heart disease, especially earlier in life. This disparity is often attributed to the protective role of estrogen in premenopausal women. However, as Dr. Verma points out, postmenopausal women lose that hormonal advantage, making their risk nearly equivalent to men’s. “It’s a bit of a misnomer to say women are safer from heart disease,” he notes. “Cardiovascular disease is still a leading cause of death and disability in females.”
Ethnic background also plays a role. South Asians, for example, are known to be at a significantly higher risk of heart disease, often due to a combination of genetic predisposition and lifestyle factors.
A Breakthrough in Prevention: The SELECT Trial
One of the most exciting advancements in recent years comes from the SELECT trial—a global study evaluating the cardiovascular benefits of semaglutide (known commercially as Ozempic or Wegovy). While this medication is best known for its effectiveness in weight loss and diabetes control, SELECT revealed something more profound: semaglutide significantly reduces the risk of major cardiovascular events in people with existing heart disease, even if they don’t have diabetes.
The trial included over 17,000 individuals worldwide who were overweight or obese and had a history of heart attack, stroke, or blocked arteries. The results were remarkable—semaglutide led to a 20% reduction in heart attacks, strokes, and cardiovascular deaths.
“This is not just a weight-loss drug,” Dr. Verma emphasizes. “It’s a disease-modifying therapy that not only helps with weight and sugar control but can save lives by preventing fatal events.”
Beyond Weight Loss: The Full Scope of Semaglutide’s Benefits
A key takeaway from the SELECT study is that semaglutide’s benefits aren’t solely tied to weight loss. While weight reduction contributes to cardiovascular improvement, the medication also acts on several other pathways. It improves blood pressure, reduces systemic inflammation, and has beneficial effects on the lining of blood vessels.
Even more compelling, patients with a BMI as low as 27 experienced the same cardiovascular benefits as those with higher BMIs, suggesting that the drug’s effectiveness is not confined to those with severe obesity. However, Dr. Verma is clear: people with BMIs under 27 should not use the medication unless they have diabetes, as that population was not included in the SELECT study.
A Glimpse into the Future: The Brain, Addiction, and Metabolism
Beyond its cardiovascular and metabolic effects, emerging research indicates that semaglutide and similar drugs may also influence brain chemistry. Early findings suggest these medications may reduce addictive behaviours such as smoking, excessive drinking, and even gambling, by modulating reward centers in the brain. Dr. Verma cautioned that these possibilities, while promising, are still under investigation and are not yet approved uses for the drug.
Still, the implications are far-reaching. If proven effective, semaglutide and related medications could offer a holistic approach to managing not only heart disease and obesity but also addiction—a powerful triad of public health challenges.
Final Thoughts: The Power of Prevention and Progress
Heart disease may be a formidable foe, but as Dr. Verma underscores, we now have tools that go beyond the basics of diet and exercise. “We can’t change our age, genetics, or sex—but we can aggressively manage what we can control,” he said.
The SELECT trial marks a turning point in how we view prevention and treatment. It opens the door to new strategies that not only treat heart disease but also prevent it—potentially adding years to life and life to years. As research continues to evolve, Canadians and people worldwide have good reason to hope that we’re moving closer to outsmarting one of the most persistent threats to our health.
