Obesity drug prevents cardiovascular events in nondiabetics

August 11, 2023

Image by Dall-E

We know that the GLP-1 drugs are exceptionally effective at helping people lose weight, and we know that these drugs decrease the incidence of heart disease in people with diabetes.  The pharmaceutical company Novo just announced results of a large (17,600 participants) randomized double-blind trial that showed that obese people without diabetes over 45 with a history of past heart disease had 20% fewer adverse cardiac events (like heart attacks and strokes) than those who got placebo. The company issued only a press release; the full study with further details will be published in an academic journal at some point in the future.

This is good news! The rate of premature heart disease declined in the US from the 1970s until about 2010, but that decline stalled. We now have a new tool to further decrease premature heart disease. Novo has had manufacturing challenges - so there is not currently enough supply to treat millions more with this medication. We expect that tirzepatide, a similar drug currently used for diabetes, will also lower the risk of adverse heart events, and this should be approved for obesity in those without diabetes sometime this fall.  Both drugs are very expensive, with net costs after rebates and discounts approaching $10,000 a year.

Implications for employers:

-        In WTW experience, almost two thirds of employers cover this class of obesity drugs, although with growing costs many are considering cutting back on this coverage.

-        This new indication will strengthen the case for covering GLP-1 drugs, although we still need lower prices to make these drugs widely available to those who will most benefit.

-        See below for further evidence that few can achieve target weights without a medical intervention.

-        In addition to drug therapy, employers can consider clinical programs to help their employees manage obesity. Drug treatments help reduce risk of cardiac events, but are typically added to lifestyle modifications. For example:

-        GLP-1 drugs are indicated as adjunct to a reduced calorie diet and physical activity for chronic weight management.

-        Statin drugs are indicated as an adjunct to diet for lowering cholesterol and triglycerides. Statins have also been conclusively demonstrated to lower the risk of adverse cardiovascular events.