Management of patients with cardiovascular disease and overweight/obesity: expert opinion on semaglutide use

Aims: Overweight and obesity are major global health challenges and key drivers of cardiovascular disease (CVD), yet patients with established CVD and excess body weight remain systematically under-recognized and undertreated. This consensus paper, developed by an Italian multidisciplinary panel of cardiology, endocrinology and obesity experts, aims to characterize the clinical phenotype of CVD patients most likely to benefit from semaglutide therapy, identify barriers to its implementation, and propose patient-centered strategies to optimize treatment pathways. Data synthesis: The document reviews the pathophysiological relevance of adiposity in cardiovascular risk, and discusses the evolving diagnostic framework beyond body mass index (e.g., waist-to-height ratio). Evidence from SELECT trial is contextualized to support semaglutide as a disease-modifying therapy with benefits largely independent of weight loss. The expert panel highlights persistent barriers related to reimbursement, organizational limitations, cultural bias, and therapeutic inertia. To address these gaps, a flexible multidisciplinary care model is proposed, centered on systematic patient identification, shared follow-up responsibilities among cardiologists, general practitioners and obesity specialists, structured clinical pathways, and digital or automated tools to reduce missed opportunities for treatment. Emphasis is placed on consistent clinician education and patient empowerment as essential components for long-term adherence and cardiometabolic risk reduction. Conclusions: Integrating semaglutide into routine cardiovascular care requires a coordinated, patient-centered approach supported by specialty networking, aligned educational frameworks, and organizational tools to streamline identification, initiation, and monitoring. Implementing these strategies can strengthen secondary prevention, reduce therapeutic inertia, and ensure that patients with CVD and excess adiposity receive timely, evidence-based, and holistic management.