The potential of GLP-1s, such as Ozempic, is expanding far beyond its initial applications. Recent discussions in the medical community have sparked excitement over its possible roles in managing heart failure, Alzheimer’s disease, and even cancer.

One physician’s provocative speculation (Harlan Krumholz, MD, SM, as quoted in The Independent) that it could be considered “a fountain of youth” highlights the treatment’s promise in not just enhancing quality of life but potentially slowing the aging process itself.

Allingham P. Ozempic hailed as ‘fountain of youth’ drug that could slow down ageing, researchers say. The Independent. August 31, 2024.

But does this claim hold any weight?

 

It wouldn’t surprise me that improving people’s health this way actually slows down the aging process.

 

Lower mortality—but longer life?

 

In one study (a subanalysis of the SELECT trial), for instance, treatment with semaglutide 2.4 mg was associated with lower rates of all-cause death during the COVID-19 pandemic.

Scirica BM,Lincoff AM, Lingvay I, et al. The effect of semaglutide on mortality and COVID-19-related deaths: An analysis from the SELECT trial. JACC. August 30, 2024.

 

The researchers concluded that “the lower rate of non-cardiovascular death with semaglutide was predominantly because of fewer infectious deaths. These findings highlight the effect of semaglutide on mortality across a broad population of patients with CV [cardiovascular disease] and obesity.”

Scirica BM,Lincoff AM, Lingvay I, et al. The effect of semaglutide on mortality and COVID-19-related deaths: An analysis from the SELECT trial. JACC. August 30, 2024.

 

 

 

What the data can't say

 

Several studies, including those presented at the August 2024 European Society of Cardiology (ESC) meeting, have now shown the benefits of semaglutide in reducing all-cause mortality as well as mortality from CV, including heart failure, in patients with obesity or overweight, both with and without diabetes.

Pagidipati NJ. Six substudies from the semaglutide trials: Identifying mechanisms of benefit and whom to treat. JACC. August 30, 2024.

 

“I would say if you’re improving someone’s cardiometabolic health substantially, then you are putting them in a position to live longer and better,” Dr. Krumholz clarified. “It’s not just avoiding heart attacks. These are health promoters.”

Allingham P. Ozempic hailed as ‘fountain of youth’ drug that could slow down ageing, researchers say. The Independent. August 31, 2024.

 

 

Dr. Krumholz’s commentary on the presented studies, of course, is not the same as actual population-based studies over decades showing measurable improvement in longevity or even laboratory-based studies showing an increase in telomere length with semaglutide treatment. As of today, those outcomes are lacking.

 

The obesity paradox

 

At the same time, there is something to be considered as patients age: Several studies—including a longitudinal study done in China

Wang YF, Tang Z, Guo J, et al. BMI and BMI changes to all-cause mortality among the elderly in Beijing: A 20-year cohort study. Biomed Environ Sci. 2017;30(2):79–87.

—have now shown reduced mortality with a stable BMI in the overweight range of 25 to 27 kg/m(2), as compared with lower BMIs, above the age of 55. This is the very BMI (that is, 27) at which Ozempic is indicated for treatment.

 

A 2024 Swedish study has confirmed this paradox.

Gavriilidou NN, Pihlsgård M, Elmståhl S, et al. Mortality risk relationship using standard categorized BMi or knee-height based BMI—does the overweight/lower mortality paradox hold true? Aging Clin Exp Res. 2024;36(1):88.

Regardless of whether they used classic BMI calculations or knee-height BMI, the researchers found that both men and women in the age group 80 years and older who had overweight status had a lower mortality risk as compared with those who were normal/underweight.

 

Thus, the benefits and safety of Ozempic in older patients are still in question.