Jump to: Relative risk vs absolute risk | Data from SUSTAIN-6 | Does Ozempic reduce the risk of a heart attack? | Take home message
A study presented at the European Congress on Obesity showed that semaglutide (Ozempic/Wegovy) could reduce the number of major cardiovascular events (MACE), like a heart attack or stroke, by 20% compared to placebo (participants not taking the medication).
As this was a presentation and press release about the study rather than its publication, we can’t dig into the paper and analyse the numbers ourselves to outline what a ‘20% reduction’ means.
A 20% reduction sounds significant, but this is likely the relative risk reduction, which doesn’t give us a complete picture of the relationship between semaglutide and heart disease risk.
Ideally, we’d have the exact figures in the number of heart attacks or strokes between the semaglutide group and the placebo group to determine what’s known as the ‘absolute risk’.
We could also develop what’s known as a ‘normal frequency’ from these numbers.
Relative risk vs absolute risk
Here’s a hypothetical example of what we mean: we’ll use a fake drug, known as drug ‘X’.
Drug X has been designed to prevent heart attacks. 200 people are split into two groups. Group 1 receives the drug, group 2 receives a placebo (a sugar pill that looks like the drug).
- 2 people out of 100 who received drug X experienced a heart attack after 3 years.
- 4 people out of 100 who received the placebo experienced a heart attack after 3 years.
- We divide 4/100 to get the baseline absolute risk in this placebo group, which is 4%.
- We then divide 2/100 to get the absolute risk in the group taking the medication, which is 2%.
- To understand the relative risk, we divide the exposed group with the placebo group: 2%/4% = 50%
- We can then calculate the difference between 2% and 4% to understand the absolute risk, which would be 2%
This means that drug X causes a 50% relative drop in the rate of heart attacks compared to the placebo group.
A 50% relative drop sounds significant; however, as the baseline risk in the placebo group was relatively low at 4%, the absolute risk difference between the two groups was only 2%.
To put that into a normal frequency, we could say:
For every 100 people taking the medication, we can save two heart attacks over a three-year period.
This isn’t to say that drug X doesn’t work. Two heart attacks saved for every 100 people treated may convince you to take drug X.
But it’s a very different proposition than to say, ‘Drug X lowers your risk of a heart attack by 50%’.
Additionally, these numbers might increase over time, and it’s possible that three years isn’t long enough to determine the actual risk reduction benefit. But if this is the only data we have, that’s what we have to work from.
Fortunately, we have older research we can analyse also investigating the link between semaglutide and major cardiovascular events (MACEs) to provide a clearer picture of how semaglutide lowers the risk of a heart attack or stroke.
Data from SUSTAIN-6
A large human clinical trial randomised 3,297 participants living with type 2 diabetes to receive semaglutide 1 mg (Ozempic) or a placebo for two years.
The study’s main findings were that compared to placebo:
- Semaglutide lowered the relative risk of a non-fatal heart attack by 26%
- It also lowered the relative risk of a stroke by 39%
- And lowered the relative risk of a major cardiovascular event by 26%
This sounds significant. However, there was no difference between the death rate from cardiovascular disease and hospitalisation from heart failure in the two groups.
Looking at the absolute figures, this is how the study breaks down:
- 47 (2.9%) patients on semaglutide experienced a non-fatal heart attack, compared to 64 (3.9%) on placebo. An absolute risk reduction of 1%. Or, as a normal frequency, semaglutide prevented 17 heart attacks after two years.
- 27 (1.6%) patients on semaglutide experienced a stroke, compared to 44 (3.9%) on placebo. An absolute risk of 2.3%. Or, as a normal frequency, semaglutide prevented 17 strokes after two years.
- 44 (2.7%) of patients on semaglutide died due to causes related to cardiovascular disease, compared to 46 (2.8%) in the placebo group. An absolute risk of 0.1%. Or, as a normal frequency, semaglutide treatment prevented two deaths after two years.
Another study analysing the data from the SUSTAIN and PIONEER trials also found a similar reduction in risk of experiencing a major cardiovascular event (MACE) with semaglutide.
It demonstrated a 23% relative reduction in MACEs with semaglutide compared to placebo. 222 (2.1%) patients in the semaglutide group experienced a cardiovascular event, compared with 251 (3.5%) in the placebo group. An absolute risk reduction of 1.4%.
Or, as a normal frequency, in a group of 10,508 people on semaglutide, it prevented 29 heart attacks over an average follow-up time of 1.32 years.
So, does Ozempic lower your risk of a heart attack?
Overall, yes. The study suggests that over a two-year period, Ozempic reduces major cardiovascular events like heart attacks but doesn’t reduce the risk of dying of cardiovascular disease during this time.
Likely, a two-year follow-up isn’t enough time to see a true reflection in reducing deaths from cardiovascular disease with semaglutide. Future trials will likely conduct longer-term follow-ups to get a clearer picture.
Additionally, heart disease is complicated, and while semaglutide may help to improve various risk factors causally linked to the condition, such as high blood sugar and obesity, it can’t impact all other risk factors, such as smoking, lack of physical activity, and poor emotional health.
How does Ozempic reduce the risk of a heart attack?
As mentioned above, heart disease is complicated, and there are hundreds of causal factors linked to the development of the condition. However, semaglutide is likely to lower the risk of a heart attack in three areas:
- Improved insulin sensitivity
- Lower blood sugar levels
- Lower inflammation from weight loss (smaller fat cells)
These areas would require too much depth to investigate for this guide, but we’ll look into them in future guides, so stay tuned.
Take home message
Ozempic does lower the risk of major cardiovascular events and strokes compared to placebo.
However, the net benefit of the drug in terms of cardiovascular health and mortality is still to be determined in longer-term follow-up trials.
Additionally, the use of relative risk in headlines and announcements can exaggerate the effect of medications, which can be misleading for the public when deciding whether to take a medication.
By understanding the absolute risk and putting the numbers from trials into a normal frequency, people can better understand the impact of medications and make more informed decisions about treatment options.
We believe there’s no point in taking medications without changing habits
Weight-loss injections are designed as additional tools for healthy lifestyle change and might not be lifelong medications for everyone.
Instead, they should be used to help you kickstart your weight-loss journey whilst you focus on building new, healthy habits.
Consider the use of antidepressants for people living with depression. They’re not designed to cure the condition. Instead, they’re designed to allow room for therapy to treat the condition’s underlying cause.
Mounjaro and Wegovy are similar. These medications can help silence food-related thoughts and also give you a boost of confidence with more immediate weight-loss results.
This helps to buy you the time and headspace to understand why your body may have struggled to lose weight previously, and to build new long-term healthy habits.
The core focus of our medication programmes is to calm down the feeling of food noise, lower your cravings, and allow you to build healthier habits to keep the weight off for good.
The ultimate goal is to make losing weight feel second nature.
Second Nature’s medication programmes
Second Nature has two medication-supported programmes: a Wegovy weight-loss programme and a Mounjaro weight-loss programme.
If you’ve made the decision to try Wegovy or Mounjaro (assuming you’re eligible), why should you choose Second Nature over other medication providers?
For peace of mind.
Second Nature has worked with the NHS for over 6 years providing weight-loss programmes across the UK.
Whilst our Wegovy and Mounjaro weight-loss programmes are private and not currently used by the NHS, we’ve built the programmes with a focus on scientific evidence, patient safety, and data security.
We hope that our 6+ years of working with the NHS and building a track record of effective weight-loss results will give you peace of mind to give us a try
