May 2025: Oral Semaglutide and Cardiovascular Outcomes in High-Risk Type 2 Diabetes
The issue
Heart attacks and strokes remain the leading killers of people with type 2 diabetes. A large international trial found that the once‑daily tablet oral semaglutide cut those events by 14 percent versus placebo in high‑risk adults.
What do I need to know?
The study followed 9,650 adults (average age 66) who had diabetes plus established heart disease, chronic kidney disease, or both. Over four years, 12 percent of patients on oral semaglutide suffered a major cardiovascular event compared with 14 percent on standard care alone; the number needed to treat was 50 to prevent one event. Benefits were driven mainly by fewer non‑fatal heart attacks (26 percent reduction). Kidney outcomes did not improve significantly, and overall serious side‑effects were similar to placebo, though stomach upset led some people to stop the drug. The pill also modestly lowered long‑term blood sugar and trimmed about seven pounds on average.
Potential risk of cardiovascular events
Older adult with type 2 diabetes but no known heart or kidney disease.
Recommended Actions
Keep A1C, blood pressure, and cholesterol under control; stay active.
Ask the doctor whether starting a GLP‑1 medicine like semaglutide makes sense before problems appear.
Imminent risk of cardiovascular events
Diabetes plus a diagnosis such as coronary artery disease, prior angioplasty, or stage 3 chronic kidney disease.
Recommended Actions
Review current drugs and consider adding oral semaglutide to standard therapy.
Schedule follow‑up within three months to monitor tolerability (nausea, acid reflux) and weight change.
Continue aspirin, statin, and ACE‑inhibitor/ARB as prescribed.
Confirmed cardiovascular event
Recent heart attack, stroke, or hospitalization for heart failure.
Recommended Actions
Discuss starting or continuing oral semaglutide unless contraindicated.
Enroll in a cardiac‑rehab or structured exercise program.
Monitor kidney function and any gastrointestinal side‑effects; report severe or persistent symptoms promptly.
What can I do?
If you or a loved one has diabetes, bring up three questions at the next visit: (1) “Am I at potential, imminent, or confirmed cardiovascular risk?” (2) “Would the oral GLP‑1 pill semaglutide help protect my heart?” and (3) “How will we watch for side‑effects?” Take the tablet on an empty stomach with a sip of water and wait 30 minutes before eating. Call the care team if nausea, vomiting, or sudden weight loss occurs, or if new chest pain, shortness of breath, or swelling develops. Combining medication, lifestyle changes, and regular check‑ups offers the best chance to stay healthy longer.
