From this summer, more than a million people in England who have survived a heart attack or stroke will be offered a weekly injection that could stop it happening again. The drug is semaglutide — better known as the weight-loss jab Wegovy — and clinical trials show it reduces the risk of serious cardiovascular events by 20%.

But if you live in Scotland, where heart disease kills 41 people every day and Glasgow has the highest premature cardiovascular death rate in Britain, you will have to wait. How long? Nobody can say yet.

What NICE Has Approved — and Why It Matters

On 1 April, the National Institute for Health and Care Excellence (NICE) recommended semaglutide as a treatment option for adults in England and Wales who have previously had a heart attack, stroke, or serious circulation problems in their legs (peripheral arterial disease), and who have a BMI of 27 or above.

The evidence is striking. In the SELECT trial — one of the largest cardiovascular drug studies in recent years, involving 17,604 patients — those taking semaglutide alongside their existing heart medications were 20% less likely to suffer a major cardiovascular event than those on a placebo. Crucially, the benefits appeared before significant weight loss occurred, suggesting the drug acts directly on the heart and blood vessels.

"So-called 'weight loss drugs' like semaglutide have proven benefits beyond reducing the number on the scales — they are now considered important medicines for preventing deadly heart attacks and strokes," said Dr Sonya Babu-Narayan, Clinical Director at the British Heart Foundation.

Scotland's Separate Pathway

NICE guidance does not apply in Scotland. North of the border, new medicines must be assessed by the Scottish Medicines Consortium (SMC), which operates its own independent review process.

The SMC has confirmed it has received a submission for Wegovy's cardiovascular indication (reference SMC2872), with a patient group submission deadline of 6 April 2026. But neither the SMC meeting date nor the publication date for its advice has been confirmed.

The SMC's standard assessment timeline is 18 weeks from scheduling to publication — meaning that even in the best case, Scottish patients may not see a decision until late summer or autumn. For complex submissions, the process can stretch to 22 to 26 weeks.

That gap matters enormously. Scotland has some of the most acute cardiovascular disease rates in Western Europe.

Why Scotland Can't Afford to Wait

The numbers are stark. Glasgow City's premature cardiovascular death rate — 139 per 100,000 people — is more than three times higher than Hart in Hampshire, which records just 40 per 100,000. Five of the ten worst-performing areas in the UK for premature heart disease deaths are in Scotland.

Cardiovascular disease costs NHS Scotland an estimated £800 million every year. The burden falls hardest on the poorest communities: GP practices in Scotland's most deprived areas have nearly twice the rate of coronary heart disease among women compared to the least deprived areas, according to analysis by IPPR and the British Heart Foundation.

Professor Nawwar Al-Attar, a consultant cardiac and transplant surgeon at the Golden Jubilee National Hospital in Clydebank, has warned: "Historically, Scotland has had a high incidence of cardiovascular disease compared to the rest of the UK. Although great improvements have been made in prevention and treatment, coronary heart disease is still Scotland's biggest killer."

What Wegovy Is — and Who Could Qualify

Semaglutide is a GLP-1 receptor agonist — it mimics a gut hormone that regulates appetite and blood sugar. It is already prescribed on the NHS for weight management and, under the brand name Ozempic, for type 2 diabetes.

Under the new NICE guidance, it would be offered as a weekly self-administered injection to adults who:

  • Have previously had a heart attack, stroke, or peripheral arterial disease
  • Have a BMI of 27 or above
  • Are willing to follow a reduced-calorie diet and increase physical activity

It is prescribed alongside — not instead of — existing medications such as statins.

In plain terms, a 20% reduction in major cardiovascular events means that for every five heart attacks or strokes that would have occurred among eligible patients, one could be prevented.

The Clock Is Ticking

England has opened a door. The question now is how quickly Scotland walks through it.

Scotland's Heart Disease Action Plan, which has driven improvements in cardiovascular services since 2021, is due to expire this year — with no commitment to renewal. IPPR and the BHF have warned that without a successor plan, hard-won progress on prevention and early detection could stall.

With the SMC review timeline still unconfirmed, Scottish patients with cardiovascular disease are left watching from the wrong side of the border as a potentially life-changing treatment rolls out in England.

Dr Babu-Narayan's words carry particular weight north of the border: "It's so important that when we get new and effective medicines which prevent cardiovascular disease complications, like semaglutide, that they get to everyone who could benefit as soon as possible."

Everyone means Scotland too.