Allocation of Semaglutide According to Coronary Artery Calcium and BMI

🥇 Top 1% JournalJan 11, 2025JACC. Cardiovascular imaging

Using Body Weight and Heart Artery Calcium to Guide Semaglutide Treatment in Heart Disease Risk

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Abstract

Among 3,129 participants, 49% had coronary artery calcium (CAC) present, which is linked to significantly higher risks of major adverse cardiovascular events and other health issues.

CAC scores indicate a 2.2-fold increased risk for major adverse cardiovascular events in individuals with CAC ≥300 compared to those with CAC = 0.
Higher CAC levels are associated with increased risks for heart failure, chronic kidney disease, and all-cause mortality.
Five-year number-needed-to-treat calculations reveal considerable differences in risk reduction for those with CAC = 0 versus CAC ≥300 across various health outcomes.
The findings suggest that measuring CAC could improve the allocation of semaglutide therapy, potentially enhancing patient care for those without diabetes or established cardiovascular disease.

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BACKGROUND: Implementation of semaglutide weight loss therapy has been challenging due to drug supply and cost, underscoring a need to identify those who derive the greatest absolute benefit.

OBJECTIVES: Allocation of semaglutide was modeled according to coronary artery calcium (CAC) among individuals without diabetes or established atherosclerotic cardiovascular disease (CVD).

METHODS: In this analysis, 3,129 participants in the MESA (Multi-Ethnic Study of Atherosclerosis) without diabetes or clinical CVD met body mass index criteria for semaglutide and underwent CAC scoring on noncontrast cardiac computed tomography. Cox proportional hazards regression assessed the association of CAC with major adverse cardiovascular events (MACE), heart failure (HF), chronic kidney disease (CKD), and all-cause mortality. Risk reduction estimates from the SELECT (Semaglutide Effects on Heart Disease and Stroke in Patients with Overweight or Obesity) trial (median follow-up: 3.3 years) were applied to observed incidence rates for semaglutide 5-year number-needed-to-treat calculations.

RESULTS: Mean age was 61.2 years, 54% were female, 62% were non-White, mean body mass index was 31.8 kg/m, and 49% had CAC. Compared with CAC = 0, CAC ≥300 conferred a 2.2-fold higher risk for MACE (HR: 2.16 [95% CI: 1.57-2.99]; P < 0.001). Higher risks for HF (HR: 2.80 [95% CI: 1.81-4.35]; P < 0.001), CKD (HR: 1.59 [95% CI: 1.15-2.22]; P = 0.006), and all-cause mortality (HR: 1.35 [95% CI: 1.08-1.69]; P = 0.009) comparing CAC ≥300 vs CAC = 0 were also observed. There were large 5-year number-needed-to-treat differences between CAC = 0 and CAC ≥300 for MACE (653 vs 79), HF (1,094 vs 144), CKD (1,044 vs 144), and all-cause mortality (408 vs 98). 2

CONCLUSIONS: Measurement of CAC may enhance value of care with weight loss dose semaglutide in those without diabetes or clinical CVD, improving allocation of a limited health care resource.

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