Real-world impact of oral semaglutide on inflammatory markers in patients at high cardiovascular risk.

BACKGROUND AND OBJECTIVE: Inflammation plays a central role in the pathophysiology of atherosclerosis and contributes to residual cardiovascular risk (CVR). High-sensitivity C-reactive protein (hs-CRP) and fibrinogen are considered key biomarkers in this context. Although GLP-1 receptor agonists have demonstrated anti-inflammatory effects, real-world evidence on oral semaglutide is limited. The objective of this study was to evaluate the impact of oral semaglutide on inflammatory markers in patients with high cardiovascular risk (CVR) in routine clinical practice. MATERIALS AND METHODS: This was an observational study that included adult patients receiving treatment with oral semaglutide. The primary endpoint was the change in hs-CRP and fibrinogen levels. Secondary objectives included evaluating modifications in glycated hemoglobin (HbA1c), safety, and predictors of sustained anti-inflammatory response, defined as hs-CRP ≤ 2 mg/L. RESULTS: A total of 164 patients were included (mean age 68 ± 9 years; 37.6% women). After a mean follow-up of 370 ± 42 days, hs-CRP decreased from 6.7 ± 9.1 mg/L to 2.9 ± 6.1 mg/L (p < 0.001) and fibrinogen decreased from 428 ± 130 mg/dL to 370 ± 113 mg/dL (p < 0.001). Sixty percent (60%) achieved hs-CRP ≤ 2 mg/L, with a favorable safety profile. In multivariate analysis, baseline hs-CRP and continuity of semaglutide treatment emerged as independent predictors of hs-CRP ≤ 2 mg/L. CONCLUSIONS: Under real-world conditions, treatment with oral semaglutide significantly reduced hs-CRP and fibrinogen levels in patients with high CVR. This effect may help to explain the cardiovascular benefit observed in clinical trials.