Novo Nordisk Foundation and cardiometabolic diseases 

Heart

Following a trip to Copenhagen, Denmark, DDW’s Megan Thomas reflects on the Novo Nordisk Foundation’s efforts to tackle cardiometabolic diseases. 

According to presentations given at the Foundation’s HQ, more than 30% of the world’s population is overweight or obese and 537 million people live with diabetes. The World Health Organization (WHO) reports that cardiovascular diseases (CVDs) are the leading cause of death globally, stating that an estimated 17.9 million people died from CVDs in 2019, representing 32% of all global deaths1. Of these deaths, says the WHO, 85% were due to heart attack and stroke1.  

The Novo Nordisk Foundation believes it is well positioned to address the challenges posed by cardiometabolic diseases by taking the ‘cradle to grave’ approach.  

Where does the money come from? 

One might conflate these philanthropic efforts by the Novo Nordisk Foundation to mean the foundation is by nature a charity owned by Novo Nordisk. Instead, Novo Holdings is a Danish private limited liability company and the controlling shareholder of Novo Nordisk. Novo Holdings is wholly owned by the Novo Nordisk Foundation, which is self-governing.  

In simpler terms, this means the financial success of Novo Nordisk’s range of drugs for obesity, diabetes, haemophilia, growth disorder and hormone replacement therapy, in turn provide the Novo Nordisk Foundation with the capital they use to set up its initiatives.   

According to the Washington Post2, Novo Nordisk turned an annual profit of 83.7 billion DKK ($11.97 billion) in 2023, 51% higher than 2022, marking the company’s largest annual net profit going back to 1989, according to data from S&P Global Market Intelligence1. The publication confirms that Ozempic accounted for 41% of Novo’s total sales in 2023, equivalent to nearly $14 billion, with two-thirds of the drug’s sales coming from the United States. Wegovy brought in sales of about $4.5 billion. When reflecting on the profits that Novo Nordisk’s obesity drugs Ozempic and Wegovy (semaglutide) made, it is valuable to observe where this money is being spent. The fight against cardiometabolic disease is one example.   

Maternal influence  

Through early intervention studies, the Foundation aims to take action before a child is born. This is reflected in its LiP-TOP-FiT, PRE-STORK and PREPARE-CHILD studies.  

The Foundation awarded a grant of DKK 11.9 million ($1.7 million) over a four-year period for Long-term Follow-up on Childhood Adiposity after Randomised Controlled Lifestyle Interventions in Pregnancy (the LiP-TOP-Fit Study). In addition, the Foundation awarded a grant of DKK 23.9 million ($3.4 million) over a five-year period for Healthy Lifestyle Before and During Pregnancy to Prevent Childhood Obesity (the PRE-STORK Trial). Moreover, a grant of DKK 23.9 million ($3.4 million) was awarded over a five-year period for the Pre-pregnancy Weight Loss and Reducing Childhood Overweight project (PREPARE CHILD), a randomised controlled trial. Together, this research aims to generate evidence for advising and guiding future parents before and during pregnancy. 

Professor Arne Astrup, Senior Vice President and Head of Obesity and Nutritional Science at the Novo Nordisk Foundation, is responsible for the Foundation’s activities to promote healthy weight. He thinks that the amount of money awarded in total is unique for research in this very specific field and that the research projects complement each other and the international research in this field. He said: “A single study can never form the basis for recommendations. The new projects will build on international research and help to provide additional data and thus provide increased assurance that the results are correct. The three studies complement each other very well and are a Danish element that can make a very significant contribution to understanding some of the reasons underlying why some children struggle to maintain a healthy weight whereas others do not, and opens the possibility to prevent childhood obesity by tackling mother’s overweight before conception.” 

Obesity prevention 

After this critical maternal influence phase before birth, the Foundation focuses on obesity prevention in children aged 0-18. This is achieved through the Centre for Childhood Health, the Healthy Weight Alliance, the MORE2SLEEP study and Generation Healthy Kids.  

In 2020, the Novo Nordisk Foundation awarded a DKK 1 billion ($14.3 billion) grant towards the establishment of the Centre for Childhood Health, which was developed in collaboration with the Danish Ministry of Health, which added DKK 100 million ($14.32 million) to the funding. It started up on 1 January 2023. Morten Grønbæk, CEO of the Centre for Childhood Health, said: “A child’s early development, health and well-being strongly affect how the child fares later in life. In the centre, we will therefore create more knowledge about which initiatives effectively promote both healthy weight and well-being among children and adolescents.”  

A strategic focus for the Foundation from 2019 to 2023 was to ensure healthy weight among children and youth in Denmark through initiatives that tackle the determinants of overweight to reduce the derived effects, including impaired health and well-being, low self-esteem, social isolation and exclusion. The Foundation facilitated the establishment of, and continues to support, the Healthy Weight Alliance, which was one of the first initiatives to catalyse this strategy. As such, an interdisciplinary range of researchers and practitioners were gathered to obtain and spread evidence within the field and put overweight and its consequences on the public agenda.  

The Department of Nutrition, Exercise and Sports at the University of Copenhagen, the Danish Center for Sleep Medicine at Rigshospitalet in Copenhagen and several other partners in Denmark and abroad have launched MORE2SLEEP, a research collaboration which the Foundation is supporting with a grant of approximately DKK 25 million ($4 million). Researchers will study the effect of extra sleep on weight, metabolism and learning among six- to nine-year-old children who sleep too little. The head of MORE2SLEEP, Faidon Magkos, Professor at the Department of Nutrition, Exercise and Sports of the University of Copenhagen, said: “Limited available evidence from experimental studies of adults suggests that extra sleep improves eating behaviour and body weight homeostasis. We will test this hypothesis among children. With the team of researchers we have gathered and with the research project we have designed, MORE2SLEEP has the potential to become a milestone for understanding the mechanisms between sleep duration, body weight, metabolism and learning.” 

Generation Healthy Kids is a research project funded by the Novo Nordisk Foundation and conducted by four closely collaborating research institutions: 

  1. University of Copenhagen, Department of Nutrition, Exercise and Sports,  
  2. University of Southern Denmark, Department of Sports Science and Clinical Biomechanics 
  3. Bispebjerg and Frederiksberg Hospital, Center for Clinical Research and Prevention 
  4. University of Southern Denmark, National Institute of Public Health.  

Through a cluster-randomised controlled two-year trial, children from 12 intervention schools will be compared to children from 12 control schools with the end goal of promoting healthy weight, development and well-being among children aged 6-9, as well as counteracting social inequality in health.  

Prevention and treatment 

Alongside early preventative measures, CVD is being tackled and prevented in young to middle-aged adults by the Novo Nordisk Foundation in a number of ways. 

In partnership with Rigshospitalet and the Spanish National Center for Cardiovascular Research (CNIC), The Novo Nordisk Foundation have established REACT, an early detection and monitoring initiative for atherosclerosis, with the aim of preventing its cardiovascular complications and in turn improving people’s cardiometabolic health, life quality and longevity of life.  

As for the work at the Danish Cardiovascular Academy, based at Aarhus University, this is a nationwide academy focused on strengthening research, training and education across cardiovascular disciplines by improving the diagnosis, treatment and prevention of CVD. Following its inception, the Novo Nordisk Foundation awarded a grant of DKK 150 million ($21.46 million) to the academy.  

On the other hand, the Novo Nordisk Foundation Center for Basic Metabolic Research aims to deliver world-class research in tackling some of today’s biggest health challenges. In April 2024, Professor Juleen Zierath of the center was awarded a prestigious grant by the European Research Council to study how circadian rhythms control type 2 diabetes. The research explores the mechanisms that underpin the relationship between the circadian clock, diet and exercise, and metabolism, and their dysfunction in type 2 diabetes. 

There is also the Danish Diabetes and Endocrine Academy (DDEA) working alongside these other initiatives to prevent CVD. Simply put, the purpose of the academy is to strengthen the quality of Danish diabetes and endocrine research and research education. This is achieved with a multi-pronged strategy that encompasses: education and talent development events for early-career researchers; networking and national as well as international collaborations across research fields with academia, hospitals, the life science industry; NGO grants for PhDs, postdocs and visiting professors; and communication and outreach.  

The Novo Nordisk Foundation Center for Genomic Mechanisms of Disease is an initiative which facilitates collaboration between the Broad Institute and Danish researchers that are investigating the genetics and gene regulation of common complex disease, including type 2 diabetes and obesity. When this was launched in September 2021, it was supported by a grant of up to $47.5 million from the Foundation, which had committed itself for a five-year period (2021-2026), with the possibility of extending its support of the centre.  

The Lighthouse Consortium of Obesity Management (LightCOM) is an initiative in which researchers from Denmark and the United Kingdom are developing and testing new obesity management programmes, backed with a grant from the Foundation of DKK 180 million ($25.74 million). The project aims to develop, implement and evaluate new obesity management programmes that will be offered in both primary and secondary care while accommodating global challenges related to obesity.  

There are seven Steno Diabetes Centers across Denmark, Greenland and the Faroe Islands, and these are designed to help people with diabetes live longer and healthier lives. In addition to treating thousands of diabetes patients, they also make an impact through research, education and preventive intervention. This balance of prevention and treatment is a key to the multitude of projects being undertaken simultaneously.  

Conclusion  

It is clear that the Novo Nordisk Foundation is committed to tackling the root causes of cardiometabolic diseases, rather than just the treatment. From cradle to grave, there appears to be a dedicated network of support, research, education and quality data leading the way.  

References
  1. https://www.who.int/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds) 
  2. https://www.washingtonpost.com/business/2024/01/31/novo-nordisk-wegovy-supply-earnings/  

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