Semaglutide is famous for helping people shed kilograms. Starting this summer, 1.2 million people in England will receive it for a different reason: to stop their hearts from failing them a second time.

The National Institute for Health and Care Excellence (NICE) has recommended that semaglutide — best known by the brand name Wegovy — be offered to anyone who has survived a heart attack, stroke, or serious circulation problems in their legs, and who has a body mass index (BMI) of 27 or above. That is the “overweight” threshold, not obese — a deliberate expansion beyond the drug’s existing role in weight management.

This is not a weight-loss programme with cardiovascular side benefits. The recommendation is specifically about preventing heart attacks and strokes, and the evidence behind it reshapes what we thought we knew about how these drugs work.

A 20% Reduction — Before the Weight Comes Off

The SELECT trial, involving 17,604 participants, found that semaglutide reduced the risk of a major cardiovascular event — heart attack, stroke, or cardiovascular death — by 20% compared to placebo. Both groups continued receiving standard care, including statins and blood-pressure medications.

The critical finding: the cardiovascular benefit appeared early in the trial, before participants had lost significant weight. NICE concluded that this suggests semaglutide acts directly on the heart and blood vessels, not solely through the mechanism of weight reduction.

A subsequent analysis led by University College London, published in the Lancet, confirmed that the protective effect held regardless of how many kilograms patients actually lost.

Helen Knight, NICE’s director of medicines evaluation, called the trial evidence “compelling,” adding that patients taking semaglutide alongside existing heart medicines were “significantly less likely to have another heart attack or stroke.”

The Cost of a Quieter Heart

NICE concluded that semaglutide represents good value for the NHS, which has negotiated a confidential pricing deal with Novo Nordisk, the drug’s manufacturer. The exact price has not been disclosed, but the committee determined that the cost per quality-adjusted life year fell well within its acceptable range.

Each year, the UK sees roughly 100,000 hospital admissions for heart attacks, another 100,000 strokes, and an estimated 350,000 people living with peripheral arterial disease. Patients who survive one event face a significantly elevated risk of another. Around seven in ten cases of cardiovascular disease are considered preventable.

Helen Williams, NHS England’s national clinical director for cardiovascular disease prevention, said the treatment “could help prevent thousands of future major cardiovascular events and give many people the chance at a longer and healthier life.”

A Global Test Case

The UK is not the first country to explore GLP-1 drugs for cardiovascular prevention, but the breadth of this recommendation — covering 1.2 million patients with a relatively low BMI threshold — makes it one of the most ambitious deployments anywhere in the world. Health systems across Europe and North America are watching closely.

Prof Riyaz Patel of UCL welcomed the move but flagged a practical concern: whether the NHS has the capacity to deliver the drug at this scale. Patients will need individual assessment by a GP or specialist, and rollout is expected to begin this summer.

Not everyone is unreservedly enthusiastic. Prof Robert Storey, a heart-health expert at the University of Sheffield, cautioned that GLP-1 drugs can reduce muscle mass as well as fat, recommending resistance training to counteract the effect.

A Drug With a Growing Résumé

Semaglutide was developed for diabetes, repurposed for obesity, and is now being deployed as a cardiovascular intervention. Each new application has expanded the eligible population — and the financial and logistical stakes for the health systems asked to pay for it.

Dr Sonya Babu-Narayan, clinical director at the British Heart Foundation, put it plainly: “So-called ‘weight loss drugs’ like semaglutide have proven benefits beyond reducing the number on the scales — they are now considered important medicines for preventing deadly heart attacks and strokes.”

The question for the NHS, and for every system watching from abroad, is whether infrastructure can keep pace with what the science now says these drugs can do.

Sources