The decision by the National Institute for Health and Care Excellence (NICE) marks the first time it has been approved in the UK specifically to prevent further heart problems, rather than simply for weight loss. Until now, medicines such as Wegovy and Ozempic have been used mainly for obesity and diabetes. More than a million people with heart disease are set to be offered weight-loss injections on the NHS. Semaglutide is best known as a weight-loss drug, but the NICE recommendation is specifically about preventing heart attacks and strokes.
Patients who have had a heart attack or stroke will be eligible for a weekly Wegovy jab to cut their chances of another life-threatening event. The National Institute for Health and Care Excellence (NICE) said people with a body mass index (BMI) score of 27 or above who have had a heart attack, stroke or serious circulation problem in their legs should be offered semaglutide to ward off life-threatening cardiovascular events. NHS England said about 1.2 million people could benefit. Around eight million people in the UK are living with cardiovascular disease, with an estimated 1.2 million thought to have a body mass index (BMI) above 27 and therefore meeting the new eligibility criteria.
The move follows results from the landmark SELECT trial of more than 17,000 patients with cardiovascular disease. Participants were given weekly injections of semaglutide – the active ingredient in Wegovy – alongside their usual care. Clinical trials found semaglutide reduces the risk of a heart attack, stroke or cardiovascular death. Those on the drug were 20 per cent less likely to suffer a major heart event, such as a heart attack or stroke, than those given a placebo. Crucially, researchers found the benefit emerged early in the trial, before patients had lost significant weight. This suggests the drug's impact may not be solely down to weight loss, but could involve direct effects on the heart and blood vessels. Previous analysis found semaglutide reduced the risk of major cardiac events by 20%. In October, researchers said they had now found the benefit was apparent regardless of how much weight people lost while taking the drug.
Growing evidence suggests they also act directly on the heart and blood vessels, lowering the risk of future events. The Guardian reported last year how the largest study of its kind, led by University College London (UCL), found semaglutide cuts the risk of heart attack or stroke regardless of how many kilograms people lose. The findings, published in the Lancet, suggested the drugs could have wider benefits for patients beyond weight loss, so should not be restricted to the most obese patients. On Wednesday, Helen Knight, the director of medicines evaluation at NICE, said the evidence from the UCL study was compelling. According to Knight, it showed people taking semaglutide with existing heart medicines were significantly less likely to have another heart attack or stroke.
Heart disease remains one of the biggest killers in the UK, responsible for more than 460 deaths a day – roughly one every three minutes. Each year, more than 200,000 people suffer a heart attack or stroke. Patients with conditions such as peripheral arterial disease, or those who have already experienced a heart attack or stroke, face a significantly higher risk of another potentially fatal event.
The drug will be offered alongside cholesterol-lowering statins and blood pressure medication, as well as diet and lifestyle advice. The weekly injections will be an extra treatment, offered on top of medicines people are already taking, such as statins, and alongside a reduced-calorie diet and increased physical activity for those at high risk of another serious event.
NICE's independent committee concluded that semaglutide offers a meaningful benefit for these patients and represents a cost-effective use of NHS resources. The guidance is expected to see the drug incorporated into routine cardiovascular care over the coming years as part of the NHS's long-term plan.
Wegovy is already available on the NHS through specialist weight management services. Semaglutide (Wegovy) is already available on the health service for some people living with obesity, and also offered under the brand name Ozempic to treat type 2 diabetes. An estimated one in 50 UK adults now use fat jabs with demand soaring since 2023 when NICE approved Wegovy for weight loss on the NHS. The NICE green light is draft guidance. The exact timing for implementation and widespread availability to eligible patients has not been confirmed, nor have the specific costs to the NHS of providing semaglutide to over a million additional patients. It remains unclear how the NHS will ensure sufficient supply to meet increased demand or what specific processes will identify and enroll the estimated 1.2 million eligible patients.