Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, Mitsuaki Sawano, MD, PhD ⊕Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, CT
Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, Brianna M. Goodwin Cartwright, MS ⊕Truveta, Inc, Bellevue, WA, Patricia D. Rodriguez, PhD, MPH ⊕Truveta, Inc, Bellevue, WA, Samuel Gratzl PhD ⊕Truveta, Inc, Bellevue, WA, Lesley H. Curtis, PhD ⊕Departments of Population Health Sciences and Medicine, Duke University School of Medicine, Durham, NC,, Ania Jastreboff, MD, PhD ⊕Y-Weight Yale Obesity Research Center, Section of Endocrinology and Metabolism, Department of Medicine, Yale School of Medicine, New Haven, CT
Section of Pediatric Endocrinology, Department of Pediatrics, Yale School of Medicine, New Haven, CT, Yuan Lu, PhD ⊕Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, CT
Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT
Department of Biomedical Informatics and Data Sciences, Yale School of Medicine, New Haven, CT,Nicholas Stucky, MD, PhD ⊕Truveta, Inc, Bellevue, WA
In March 2024, the U.S. Food and Drug Administration (FDA) approved a new indication for semaglutide to reduce cardiovascular risk in adults with established cardiovascular disease (CVD) and overweight or obesity. This expansion followed the SELECT (Semaglutide Effects on Cardiovascular Outcomes in People with Overweight or Obesity) trial, which demonstrated cardiovascular benefit among adults with overweight/obesity and without diabetes. Whether, and how quickly, this evidence and regulatory change have translated into clinical practice remains uncertain.
By analyzing dispensing data, this study examined trends in the first-time dispensing of semaglutide and tirzepatide among adults with CVD and overweight or obesity. It focused on immediate changes following FDA approval and hypothesized that, although use increased, overall uptake remained substantially below the level expected if all eligible patients were treated— representing a missed opportunity, particularly among those at the higher end of cardiovascular risk.
Results
In a national cohort of more than 2 million eligible adults observed from January 2021 through May 2025, the U.S. Food and Drug Administration approval was associated with an immediate 23% increase in first-time semaglutide dispensing, followed by a gradual decline in subsequent months. No corresponding immediate change was observed for tirzepatide, which instead demonstrated a steady, sustained rise in first-time dispensing over time. Nevertheless, the overall proportion of eligible adults receiving either drug remained far below the level expected if all who could benefit were treated.
You can read the full study in JACC: Advances.