Published Mar 16, 2026 | 7:00 AM ⚊ Updated Mar 16, 2026 | 7:00 AM
Recent studies show semaglutide benefits patients with obesity-related heart failure.
Synopsis: A national panel of Indian cardiologists has recommended semaglutide for patients with obesity and cardiovascular disease, saying obesity should be treated as a chronic medical condition rather than a lifestyle issue. Evidence from major clinical trials shows the drug can reduce heart attacks and strokes by 20 percent and produce average weight loss of 13–16 percent.
A national panel of Indian cardiologists has recommended the use of semaglutide in cardiovascular care, calling obesity a chronic disease that requires active treatment to reduce the risk of heart attack and stroke.
“Obesity is increasingly recognized as a chronic, relapsing, and progressive disease that acts as a major upstream driver of cardiovascular, kidney, and metabolic disorders, with South Asians experiencing heightened vulnerability at lower adiposity thresholds,” the panel stated.
The recommendation comes from a consensus paper published in the Journal of the Association of Physicians of India. The panel reviewed major global clinical trials and concluded that the drug causes significant weight loss and lowers cardiovascular risk.
The consensus meeting took place on 12 October 2025 in Mumbai and brought together cardiologists from across India to develop “evidence-based, practice-oriented recommendations for integrating semaglutide into cardiovascular care pathways.”
“Obesity is recognized as a chronic, relapsing, progressive disease, and active treatment of adiposity is a core component of cardiovascular prevention and long-term disease modification,” the panel stated.
“Semaglutide represents a practice-changing therapy that addresses core pathophysiological drivers of atherosclerotic cardiovascular disease and heart failure through integrated modulation of adiposity and metabolic dysfunction,” the authors wrote.
They said that semaglutide is “a disease-modifying therapy capable of addressing the underlying metabolic drivers of cardiovascular disease and can play a central role in tackling the growing burden of obesity-related heart disease.”
The SELECT trial, which studied more than 17,000 adults with overweight or obesity and established cardiovascular disease, showed that semaglutide reduced major cardiovascular events by 20 percent. This included fewer heart attacks and strokes.
“SELECT demonstrated a significant reduction in major adverse cardiovascular events in adults with overweight or obesity and established atherosclerotic cardiovascular disease, independent of diabetes status,” the panel wrote.
The benefit appeared even in people without diabetes. The authors noted the drug produces “improvements in blood pressure, glycemic control, inflammatory markers, and hepatic steatosis.”
Clinical trials reviewed in the paper show semaglutide produces average weight loss of 13–16 percent when used at weekly doses of 2.4 mg. Many patients lost at least five percent of their body weight, while higher doses in newer studies showed even greater reductions.
The panel said such levels of weight loss are difficult to achieve through lifestyle changes alone because the body activates hormonal mechanisms that drive hunger and weight regain.
“South Asians exhibit a distinctive cardiometabolic profile characterized by greater visceral adiposity, disproportionately high ectopic fat deposition in organs such as the liver and pericardium, pronounced insulin resistance, and reduced skeletal muscle mass,” the authors wrote.
As a result, cardiometabolic risk appears at lower BMI values than in other populations. The INTERHEART study showed South Asians develop heart attacks nearly six years earlier than other populations.
“This phenotype highlights the need to incorporate markers beyond BMI when assessing obesity-related cardiovascular risk in India,” the panel stated, recommending waist circumference and waist–hip ratio for more accurate risk assessment.
Recent studies show semaglutide benefits patients with obesity-related heart failure with preserved ejection fraction, a condition where traditional treatments have had limited success.
“Benefits of obesity-related HFpEF include meaningful gains in symptoms, exercise tolerance, and quality of life,” the consensus stated. Trials showed improvements in patient-reported symptoms and exercise capacity compared with placebo.
The panel said this matters because “HFpEF is driven by the interplay of hemodynamic load, chronic inflammation, and coronary microvascular dysfunction, conditions closely linked to excess adiposity.”
Semaglutide mimics GLP-1, a hormone the gut releases after eating. The natural hormone tells the pancreas to release insulin and signals the brain to stop eating. It disappears within minutes.
The drug version lasts about 168 hours—roughly seven days—allowing weekly injections. This extended presence reduces hunger, increases satiety after meals, slows stomach emptying, and improves insulin function.
The panel said the drug also reduces inflammation and ectopic fat deposits in organs like the liver and pancreas, which explains benefits beyond simple weight loss.
The consensus paper identifies specific patient groups who should receive semaglutide:
Established cardiovascular disease with overweight or obesity: The SELECT trial showed clear benefit in this population, even without diabetes.
Obesity-related heart failure: STEP-HFpEF trials showed improved symptoms and exercise capacity.
Multiple metabolic conditions: Patients with obesity plus diabetes, hypertension, or high cholesterol benefit when treatment targets multiple risk factors at once.
South Asian patients with visceral fat: High visceral fat at lower BMI supports earlier drug use. The panel recommends using waist circumference rather than BMI alone for assessment.
For Indian men, a waist circumference of 90 centimetres or higher is high risk. For Indian women, 80 centimetres or higher signals risk.
The drug shows generally good tolerance, though gastrointestinal symptoms are common during early treatment. Nausea, vomiting, and diarrhoea occur frequently but usually improve over time.
The panel identified absolute contraindications: personal or family history of medullary thyroid carcinoma, multiple endocrine neoplasia type 2, pregnancy, and breastfeeding.
Doctors should use caution in patients with prior pancreatitis, gallbladder disease, diabetic retinopathy, significant gastrointestinal disease, advanced heart failure, frailty, or sarcopenia.
Monitoring includes weight trajectory, blood pressure, blood sugar levels, kidney and liver function, and eye examinations in selected patients.
The panel said treatment must continue long term. Weight regain often occurs after stopping the drug. Clinical trials show substantial weight return when patients discontinue treatment.
This positions semaglutide as chronic disease management rather than a short-term intervention. The consensus recommends coordinating care across cardiology, endocrinology, obesity medicine, and other specialties.
Semaglutide starts at 0.25 mg weekly for the first month, then increases gradually to minimise side effects. The schedule progresses through 0.5 mg, 1.0 mg, and 1.7 mg, reaching the maintenance dose of 2.4 mg weekly after about four months.
If patients cannot tolerate a dose increase, doctors should delay escalation by four weeks. The 2.4 mg weekly dose is the evidence-based level for cardiovascular protection.
“Despite the growing evidence base, anti-obesity drugs remain underused in cardiovascular practice in India,” the consensus stated. “Effective metabolic therapies remain underutilized in cardiology practice.”
The panel said cardiologists should view obesity as a modifiable driver of cardiovascular disease and integrate semaglutide into routine care for appropriate patients.
The paper acknowledges that “access, affordability, and reimbursement remain major determinants of real-world impact.” The panel calls for policy alignment to recognise obesity as a cardiometabolic condition that warrants insurance coverage.
