Italian expert panel proposes multidisciplinary strategies to integrate semaglutide into cardiovascular care for overweight/obese patients.

Despite the clear link between overweight/obesity and cardiovascular disease (CVD), patients with established CVD and excess adiposity often remain undertreated. Current standard-of-care frequently overlooks the systemic impact of adiposity on cardiovascular risk, leading to therapeutic inertia. The SELECT trial demonstrated that semaglutide significantly reduces major adverse cardiovascular events (MACE) in individuals with overweight or obesity and established CVD, even without diabetes, highlighting its potential as a disease-modifying therapy. This consensus aims to bridge the gap between this evidence and real-world clinical practice.

An Italian multidisciplinary panel of cardiology, endocrinology, and obesity experts convened to develop a consensus paper. They reviewed the pathophysiological role of adiposity in cardiovascular risk and discussed evolving diagnostic frameworks beyond BMI, such as waist-to-height ratio. The panel contextualized evidence from the SELECT trial to support semaglutide as a disease-modifying therapy. Their process involved identifying persistent barriers to semaglutide implementation and proposing patient-centered strategies to optimize treatment pathways, focusing on a flexible multidisciplinary care model.

The expert panel identified several persistent barriers to integrating semaglutide into routine cardiovascular care, including reimbursement issues, organizational limitations, cultural biases, and therapeutic inertia. They emphasized the pathophysiological relevance of adiposity in cardiovascular risk, advocating for diagnostic frameworks beyond BMI. The consensus strongly supports semaglutide as a disease-modifying therapy, with benefits largely independent of weight loss, based on SELECT trial data. To address identified gaps, a flexible multidisciplinary care model was proposed, centered on systematic patient identification and shared follow-up responsibilities among cardiologists, general practitioners, and obesity specialists. This model includes structured clinical pathways and the use of digital or automated tools to reduce missed treatment opportunities.

Emphasis was placed on consistent clinician education and patient empowerment as essential components for long-term adherence and comprehensive cardiometabolic risk reduction.