Obesity is a cause of various metabolic syndromes and a major risk factor for cardiovascular disease. In fact, approximately 80% of patients hospitalized for cardiovascular disease are obese, and studies have shown that the risk of cardiovascular events in obese patients is up to twice as high as in those of normal weight.

Over the past 20 years, the mortality rate from obesity-related cardiovascular diseases has increased significantly, with approximately two-thirds of obesity-related deaths attributed to cardiovascular diseases.

Recently, semaglutide (brand name: Wegovy), a GLP-1 receptor agonist, has opened a new treatment paradigm in obesity treatment, demonstrating efficacy in reducing the risk of major cardiovascular events in high-risk obese patients.

Kim Kyung-hee, professor of cardiology at Incheon Sejong Hospital (Director of the Heart Transplant Center), met with Dailypharm and emphasized the importance of obesity treatment for the prevention of cardiovascular disease.

Obesity increases the risk of early onset of cardiovascular disease... “The number of young patients is also on the rise”

Obesity is a precursor to various metabolic diseases, and inflammatory substances secreted from visceral fat reduce blood vessel elasticity. According to Professor Kim, these changes lead to hypertension, diabetes, and hyperlipidemia, which in turn greatly increase the risk of early onset of coronary artery disease and heart failure even in younger age groups.

Professor Kim said, “Obesity can be a cause of all cardiovascular diseases, and there is a recent trend of an increase in patients with high blood pressure or symptoms of heart failure from a young age. Recently, the prognosis of severely obese patients is generally worse than that of the general population, but even in lean individuals, and those with sufficient muscle mass tend to have a better prognosis.”

Kim further explained, “In cases of cardiovascular diseases such as angina or heart failure, there is a tendency for weight loss and reduced muscle mass due to decreased appetite and nutrient intake. Therefore, obesity typically occurs first, followed by cardiovascular diseases in most cases.”

In other words, obesity often acts as a precursor to cardiovascular disease.

In this regard, semaglutide is regarded a game changer in the fields of obesity treatment and cardiovascular disease prevention.

Semaglutide was approved by the Ministry of Food and Drug Safety in April 2024 as an anti-obesity treatment for patients with a BMI of 27 kg/m² or higher (with comorbidities) or 30 kg/m² or higher, and in July of the same year, it was additionally approved for reducing the risk of cardiovascular events in overweight and obese adult patients with confirmed cardiovascular disease.

Professor Kim emphasized the clinical value of semaglutide not merely as a weight-loss aid but as a preventive therapy for cardiovascular disease.

In particular, KIM highlighted findings from the SELECT trial, a pivotal clinical study on semaglutide, where the drug demonstrated an additional 20% reduction in the risk of major adverse cardiovascular events (MACE) when added to standard care in patients already receiving conventional treatments.

Professor Kim explained, “In the SELECT study, approximately 90% of participants were already receiving standard treatment, but when they added semaglutide, an additional 20% reduction in MACE risk was observed. This result demonstrates that semaglutide can make a substantial contribution to improving outcomes in high-risk patient populations where existing treatments have limitations.”

According to the detailed results of the SELECT trial, over an average follow-up period of approximately 3.3 years, the semaglutide 2.4 mg group showed a statistically significant 20% reduction in the risk of cardiovascular death, nonfatal myocardial infarction, or stroke compared to the placebo group.

Professor Kim added, “Semaglutide regulates the appetite center in the brain, delays gastric emptying to induce weight loss, and further improves cardiovascular risk factors through its anti-inflammatory effects. While weight loss may also play a role, we believe that the drug’s anti-inflammatory effect plays a very significant role in cardiovascular health.”

In particular, Professor Kim emphasized that semaglutide is not simply a weight loss drug, but a scientifically proven cardiovascular treatment option.

He said, “Semaglutide is a must-use drug for patients who are severely obese or have a BMI of 27 kg/m² or higher with cardiovascular disease.”

“Limitations remain on its reimbursement... Selective reimbursement support needed for high-risk obese patients”

Although semaglutide has emerged as an important drug that should be considered as part of a standard treatment for obese patients at high risk of cardiovascular disease, there are currently practical limitations to its access in Korea. This is because it is not yet covered by insurance in Korea.

Professor Kim said, “Drugs such as semaglutide carry a certain risk of misuse, so caution should be exercised when expanding reimbursement to all patient groups. However, I believe it is desirable to allow reimbursement through strict criteria and screening procedures for high-risk groups, such as patients with severe obesity and cardiovascular complications, for whom clear therapeutic effects can be expected.”

In fact, limiting reimbursement to groups with a clear clinical need for reimbursement, such as patients with a body mass index (BMI) of 27 kg/m² or higher and obesity-related complications or cardiovascular disease, may be a realistic alternative.

Professor Kim also predicted that discussions on whether to continue reimbursement will be necessary when semaglutide significantly improves a patient’s BMI.

He said, "If patients with a BMI of 30 kg/m² or higher are administered semaglutide and their BMI falls below 26 kg/m² due to weight loss, it may be possible to consider limiting the reimbursement period to the initial 4-6 months. However, since there is currently insufficient long-term data in Korea and some patients experience weight regain after 6 months of treatment based on clinical experience, further review of long-term management strategies is necessary.”

To address current issues surrounding reimbursement coverage and costs, Professor Kim is currently conducting an economic evaluation study.

“We are analyzing how much the number of medications taken by patients can be reduced when they lose weight after 6 months or a year through bariatric surgery or semaglutide treatment, and we expect this to be significant in terms of establishing future treatment strategies and fiscal efficiency.”

Ultimately, Professor Kim believes that obesity treatment should not end with medication alone but must include comprehensive management to help patients fundamentally improve their lifestyle habits.

Professor Kim emphasized, “Patients with a BMI of 30 kg/m² or higher often find exercise difficult, so they should be actively educated to combine medication with walking exercises, maintain a high-quality diet, reduce carbohydrate intake, and abstain from alcohol and smoking.”

“Early intervention in obesity treatment is necessary to maximize preventive effects”

Professional counseling and lifestyle education support are essential to increase the effectiveness of obesity treatment. However, the reality of how difficult it is to provide sufficient counseling in the current outpatient setting is also pointed out as an issue.

Professor Kim said, “It is difficult to check blood pressure, assess the patient's condition, perform a physical examination, and explain lifestyle correction measures within the 5 minutes of consultation time allocated per patient. At least 7-10 minutes are necessary for proper treatment.”

In this regard, Professor Kim proposed the establishment of a lifestyle education program and a new fee schedule to hire dedicated personnel to overcome such limitations.

He explained, “Under the current system, separate reimbursement rates for education provided by specialized nurses need to be introduced, and institutional and financial support would also be needed to manage these personnel. Overall, I believe that establishing an environment where lifestyle education can be systematically implemented is essential to improving the quality of care for obese patients.

In particular, Professor Kim emphasized, “Patients with hypertension are at high risk of developing heart failure over time. Starting medication early and educating young obese patients with hypertension on proper lifestyle habits can prevent serious complications and repeated hospitalizations.”

In other words, Kim believes preventive treatment and lifestyle improvement efforts targeting young obese patients are expected to lead to macro-level medical cost savings in the future.

Finally, Professor Kim emphasized that “Patients should always be treated with scientifically validated medications first. Drug treatment alone is not sufficient and must be accompanied by lifestyle modifications and proper dietary management.”