Researchers who tracked more than 313,000 adults in Denmark and the United Kingdom say the group eligible for GLP-1 medications like Ozempic and Wegovy should be considerably wider than it is today.
Their argument, presented at the European Association for the Study of Diabetes (EASD) annual meeting in Milan, targets people in the lower overweight range whose blood work already looks like that of patients who do qualify.
GLP-1 receptor agonists are drugs that mimic a gut hormone released after eating. They lower blood sugar, slow how quickly the stomach empties, and cut appetite.
Semaglutide, the active ingredient in Novo Nordisk's Ozempic and Wegovy, and tirzepatide, the active ingredient in Eli Lilly's Mounjaro and Zepbound, are the best known.
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Who qualifies today
In the United States, Wegovy is approved for adults with a body mass index (BMI) of 30 or higher.
It is also approved for adults with a BMI of 27 or higher who have at least one weight-related condition such as high blood pressure or type 2 diabetes.
In March 2024, the Food and Drug Administration expanded the label to allow doctors to prescribe Wegovy specifically to cut the risk of heart attack, stroke and cardiovascular death.
That use applies to adults with known heart disease and a BMI of 27 or higher.
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That expansion was based on the SELECT trial, published in The New England Journal of Medicine, which followed 17,604 adults with overweight or obesity and pre-existing heart disease but no diabetes.
Over an average of about 40 months, major heart events occurred in 6.5 percent of people on semaglutide compared with 8.0 percent on placebo. That is a roughly 20 percent lower relative risk.
What the new analysis proposes
The Danish team, led by Dr. Karen Hvid of Copenhagen University Hospital in Herlev, pooled data from the UK Biobank and the Copenhagen General Population Study.
Participants had a BMI of 25 or higher, no known heart disease and no diabetes at the start. About 23,000 went on to develop coronary heart disease during follow-up.
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The researchers zeroed in on adults in the lower overweight band, a BMI between 25 and 26.9, who do not meet today's prescribing rules.
They looked for two markers linked to heart disease. Remnant cholesterol is the cholesterol carried by triglyceride-rich particles, and low-grade inflammation is measured in the blood as C-reactive protein.
About 44 percent of people in this BMI range in the Copenhagen cohort and 48 percent in the UK Biobank had elevated remnant cholesterol, inflammation or both.
Their added heart-disease risk sat in the same range as people who currently qualify for a GLP-1 prescription.
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Why this is not a new guideline
The findings come from an observational analysis presented at a conference, not from a randomized trial testing whether treating this group actually prevents heart attacks.
The researchers say prospective clinical trials are now needed to confirm that GLP-1 treatment would lower heart risk in people with a BMI of 25 to 26.9.
Coverage is already a moving target for people who currently qualify. Welltica has previously reported that some US employers and insurers are cutting GLP-1 benefits, which would make a wider indication harder still to translate into filled prescriptions.
For now, US eligibility remains anchored to the current FDA label. Anyone considering these drugs, or worried about their own heart risk, should talk to their own doctor about whether a cholesterol and inflammation check is appropriate.
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This article is made and published by Ida-Marie Palm Varbæk, who may have used AI in the preparation.