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Experts comment on draft NICE guidance that reccomends semaglutide to reduce the risk of heart attacks and strokes.
Prof Riyaz Patel, Professor of Cardiology, UCL; Consultant Cardiologist, UCLH and Barts Health NHS Trust; and Clinical Lead for Preventive Cardiology, Barts Heart Centre, said:
“This is a very important development. Estimates suggest there are about 4 million people in the UK living with atherosclerotic cardiovascular disease (coronary disease, strokes, arterial disease), who remain at very high risk of subsequent or further heart attacks and strokes, and related deaths despite our best available treatments. This risk comes with significant personal cost but also financial impacts on the NHS.
“NICE have based their analysis and decision primarily on the data from the SELECT study, a landmark study from 2023 which demonstrated that semaglutide, when given to people with CVD, a BMI >=27 and without diabetes, reduced their risk of future heart attacks, strokes and cardiovascular deaths by almost 20% over about 3.3 years. Crucially this benefit started early with these drugs and later analysis showed that this was seen regardless of how much weight loss was achieved. The exact mechanism as to how this drug leads to these benefits is still being investigated but is partly attributed to multiple parallel metabolic and vascular health benefits.
“Beyond weight, we know these drugs favourably impact factors like blood pressure and cholesterol, but emerging data shows they also affect behavioural factors, such as suppressing alcohol desire and possibly even nicotine cravings. As such, when used as intended, the overall health and outcome benefits may potentially make the calculated cost effectiveness estimates that NICE has calculated, even more favourable.
“While an exciting development, it is worth noting that most participants in the SELECT trial were Caucasian, so we don’t know if this benefit applies to people from all ethnicities. It is unlikely that it doesn’t work in everyone, but it is also relevant that many people from ethnic minorities may have very high risk of subsequent CVD with a BMI <27kg/m2 and may miss out – the NICE team acknowledged this but also were constrained by the lack of data on safety and efficacy at lower BMI levels.
“The only other question practically will be how this drug will be delivered and the capacity within the health system to do so. We know for example that other highly beneficial drugs like inclisiran, for cholesterol lowering have been variably delivered leading to significant postcode lotteries. ICBs must ensure this does not happen with this NICE TA, else we risk exacerbating health inequalities, when if anything, this should be a powerful tool to reduce health inequality.
“Overall, a really exciting development, for patients and doctors, giving us another powerful tool to reduce CVD risk.”
Prof Martin Whyte, Professor of Metabolic Medicine, University of Surrey, said:
“NICE’s recommendation of semaglutide for people who have already experienced a heart attack, stroke, or peripheral arterial disease, and who are living with excess weight, is warmly welcomed. These individuals face a significantly elevated risk of further cardiovascular events, and we know that traditional lifestyle and medical approaches alone are often insufficient.
“Semaglutide provides a highly effective, evidence‑based treatment option that supports meaningful weight loss, improves metabolic health, and reduces the likelihood of another life‑threatening event. This was clearly demonstrated in the SELECT trials, which reported a 1.5% absolute risk reduction in major cardiovascular events with semaglutide therapy.
“Importantly, this recommendation applies to secondary prevention in people with a BMI greater than 27 kg/m2. Existing NICE guidance for the use of semaglutide in individuals without a history of macrovascular disease remains unchanged.
“Overall, this decision represents an important step forward in improving long‑term outcomes for some of the patients at greatest cardiovascular risk.”
Dr Sonya Babu-Narayan, Clinical Director, British Heart Foundation, said:
“So-called ‘weight loss drugs’ like semaglutide have proven benefits beyond reducing the number on the scales – they are now considered important medicines for preventing deadly heart attacks and strokes.
“Today’s guidance will no doubt help save lives as cardiovascular disease is still one of the country’s biggest killers.
“That’s why it’s so important that when we get new and effective medicines which prevent cardiovascular disease complications, like semaglutide, that they get to everyone who could benefit as soon as possible.”
Prof Robert Storey, Professor of Cardiology, University of Sheffield, said:
“Huge strides have been made in reducing the risk of heart attack or stroke through improvements in our ability to control cholesterol, blood pressure and blood clot risk as well as through the development of safer and more effective stenting procedures. This has led to a steady reduction in the risk of further cardiovascular events after a heart attack. However, obesity is associated with harmful inflammation and blood clot risk that is not fully addressed by conventional treatments whereas the GLP-1 drugs help to tackle this. This was clearly demonstrated in the SELECT trial which included more than 17 thousand overweight people with cardiovascular disease and showed clearly that semaglutide reduced the risk of heart attack and other cardiovascular events. Consequently NICE’s approval of semaglutide for overweight people who have had a heart attack or stroke is a step towards even more effective management of heart attack and stroke risk. The NICE guidance appropriately considers the available evidence on the impact of injectable semaglutide and its cost-effectiveness in a UK setting. Prescribing of semaglutide needs to be appropriately targeted since GLP-1 drugs can reduce muscle mass as well as fat so physical activity, such as resistance training, is important to counteract potential negative effects on muscle strength, which may not be feasible in frail people. The benefits also need to be balanced against the risk of side effects. These issues and the need for training people to inject the drug as well as ongoing monitoring and prescribing requires the allocation of NHS resources to ensure the benefits of this NICE guidance can be fully realised.”
Prof Naveed Sattar, Professor of Cardiometabolic Medicine/Honorary Consultant, University of Glasgow, said:
“This is very good news and stems directly from high quality trial evidence. We now have medicines that not only reduce heart attacks, strokes, and peripheral arterial disease, but also simultaneously lead to meaningful weight loss – which in turn lowers the risk of many weight‑related conditions. These treatments also improve patients’ quality of life in a meaningful way, making this a genuine win–win.
“Given that so many people living with cardiovascular disease also struggle with excess weight, it’s no longer sufficient to focus solely on lipids and blood pressure. We must also address weight directly if we want to deliver the best possible outcomes for our patients. This new guidance on semaglutide enables exactly that, and represents another major turning point in the battle against obesity.
“Over time, we hope more medicines will be licensed for similar benefits, and that costs will come down further – allowing even greater impact for patients and for society.”
‘NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE Final draft guidance: Semaglutide for reducing the risk of major adverse cardiovascular events in people with cardiovascular disease and overweight or obesity’ was published by NICE at 00:01 UK time on Wednesday 1 April 2026.
Declared interests
Prof Riyaz Patel: “Have over time received speaker fees from companies like Novartis, Amarin and Novo Nordisk. Have held research grants on preventing CVD and a BHF fellowship on understanding risk of subsequent events in people with CVD. Have previously worked on NICE guidelines on lipids.”
Prof Martin Whyte: “I have no CoI.”
Dr Sonya Babu-Narayan: “No conflicts to declare.”
Prof Robert Storey: “Institutional research grants/support from AstraZeneca and Cytosorbents; and consultancy fees from Abbott, Thrombolytic Science, AstraZeneca, Boehringer Ingelheim/Lilly, Bristol Myers Squibb/Johnson & Johnson, Chiesi, Cytosorbents, Idorsia/Viatris, and Novo Nordisk.”
Prof Naveed Sattar: “NS has consulted for and/or received speaker honoraria from Abbott Laboratories, AbbVie, Afimmune, Amgen, AstraZeneca, Boehringer Ingelheim, Carmot Therapeutics, Eli Lilly, Gan & Lee, GlaxoSmithKline, Hanmi Pharmaceuticals, Janssen, Kailera, Mass Medicines, Menarini-Ricerche, Merck Sharp & Dohme, Metsera, Novartis, Novo Nordisk, Pfizer, Regeneron, Roche, Sanofi, UCB Pharma and Verdiva Bio; and received grant support paid to his University from AstraZeneca, Boehringer Ingelheim, Novartis, and Roche. No shares in any medical areas.”