Cardiologists panel in India expand use of semaglutide to cardiovascular treatment

New Delhi: In a landmark shift for Indian medicine, a national consensus published in the Journal of The Association of Physicians of India (JAPI) has formally redefined semaglutide as a critical foundation for cardiovascular treatment.

Moving beyond its reputation as a ‘diabetes or weight-loss drug,’ a panel of the country’s leading cardiologists now classifies the therapy as a multisystem tool essential for modifying the course of heart disease, kidney dysfunction and metabolic disorders in the Indian population.

Cardiovascular risks in India do not follow Western patterns

The consensus highlights a sobering reality as cardiovascular risks in India do not follow Western patterns. Indians often develop heart disease a decade earlier than their global counterparts and at significantly lower Body Mass Index (BMI) levels.

This heightened vulnerability is driven by the ‘Indian Phenotype’ characterised by high visceral fat (fat surrounding internal organs) and intense insulin resistance, even in individuals who may appear ‘thin.’

To combat this, the expert panel is urging a major shift in diagnostic standards. The consensus recommends that Indian doctors move away from a sole reliance on BMI and prioritise waist circumference as a primary risk marker:

Men: Over 90 cm

Women: Over 80 cm

More than weight loss: The science of protection

Data from major clinical trials, including the landmark SELECT study, served as the backbone for this consensus. The findings reveal that semaglutide reduces the risk of major heart attacks and strokes by 20 per cent.

Crucially, experts noted that two-thirds of these cardiovascular benefits stem from the drug’s ability to lower internal inflammation, rather than just weight reduction. The therapy also functions by:

Protecting the kidneys and liver: Safeguarding vital organs from metabolic damage.

Recalibrating brain signals: Fixing ‘biological starvation’ signals to manage appetite naturally.

Reducing mechanical strain: Improving breathing and daily activity for heart failure patients.

Who qualifies for treatment?

The panel identified six primary patient groups who stand to benefit most from semaglutide therapy:

Heart patients with Obesity - prevention of secondary cardiac events without diabetes

Relief from obesity related heart failure symptoms

Multiple morbidities - managing obesity alongside hypertension or lipid abnormalities

High Risk South Asians - Early intervention for metabolic damage at lower BMI levels

Chronic weight management - achieved sustained medically supervised weight loss

Secondary prevention - reducing symptoms in patients with heart disease

A 5-step dosing guide

To manage the transition and minimise gastrointestinal side effects, the consensus provided a clear, 17-week roadmap for Indian practitioners:

- Weeks 1–4: 0.25 mg weekly (Initiation)

- Weeks 5–8: 0.5 mg weekly

- Weeks 9–12: 1.0 mg weekly

- Weeks 13–16: 1.7 mg weekly

- Week 17+: 2.4 mg weekly (Maintenance)

If a patient cannot tolerate a specific dose, the consensus advises delaying the escalation for more than four weeks to allow the body to adjust.

A strategy for a chronic disease

The consensus concludes by framing obesity not as a lifestyle choice, but as a chronic and relapsing biological disease. By positioning semaglutide as a long-term foundational therapy, India’s medical community aims to tackle the ‘upstream’ drivers of the nation’s heart disease epidemic.

“This is about more than just a number on a scale,” the panel of cardiologists noted. “It is about fundamentally changing the biological trajectory of a patient’s heart health.”