ANMCO statement: semaglutide in the cardio-nephro-metabolic continuum

Abstract

Semaglutide, a glucagon-like peptide-1 receptor agonist, has emerged as a pivotal therapeutic agent in the management of the cardio-renal-metabolic continuum. Initially developed for glycaemic control in Type 2 diabetes mellitus, its benefits extend far beyond glucose regulation. Clinical trials have demonstrated semaglutide's potential to reduce major adverse cardiovascular events, particularly in overweight/obese patients with high cardiovascular risk, as well as improving functional capacity in patients suffering from heart failure with preserved left ventricular function. Additionally, it has shown promise in improving renal outcomes, such as slowing the progression of albuminuria and reducing the risk of chronic kidney disease in diabetic populations. These effects are likely due to its multifaceted mechanisms, including anti-inflammatory properties, weight reduction, blood pressure lowering, and direct renal protection. This review synthesizes current evidence on semaglutide's role in the interrelated domains of cardiovascular, renal, and metabolic health.

Keywords: Cardio-metabolic syndrome; Chronic kidney disease; Diabetes mellitus; Inflammation; Obesity; Semaglutide.

Figure 1

The direct effects of semaglutide on the cardio-nephro-vascular system.

Figure 2

Major actions of semaglutide in the cardio-nephro-metabolic continuum. MACE, major adverse cardiovascular events.

Figure 3

Scheme of semaglutide use in subjects with Type 2 diabetes or overweight–obesity. sc, subcutaneously.

Figure 4

Potential action mechanisms of semaglutide in the phenotype of heart failure with preserved ejection fraction with obesity. HFpEF, heart failure with preserved ejection fraction.

Figure 5

Main outcome trials on the cardio-nephro-metabolic benefits of semaglutide. CV, cardiovascular; HR, hazard ratio; CI, confidence interval; AMI, acute myocardial infarction; RR, relative risk.