If you’re looking for ways to mitigate your risk of developing cardiovascular disease or experiencing a cardiac event, such as a heart attack or stroke, glucagon-like peptide-1 (GLP-1) receptor agonists may be the answer.
New research has shown that this class of drugs may offer health benefits that go beyond managing diabetes and obesity.
“The rapidly rising obesity epidemic in the U.S., estimated to rise above 50% of the population by 2030 if left unchecked, and the associated devastating cardiometabolic outcomes of death — heart attacks and strokes — can now, fortunately, be targeted with GLP-1 or other incretin-based therapies,” says Dr. Vijaykumar S. Kasi, an interventional cardiologist at Orlando Health Heart and Vascular Institute.
The SELECT trial, which included more than 17,000 participants who were either overweight or obese (with a body mass index of at least 27) with cardiovascular disease, revealed that a once-weekly dose of semaglutide injection reduced major adverse cardiovascular events (MACE) by 20%.
Based on the landmark clinical trial, the Food and Drug Administration approved the use of semaglutide in 2024 for patients who are overweight (a BMI of 27 or greater) and obese (BMI equal to or greater than 30) with established cardiovascular disease to prevent heart attack and stroke risk. Semaglutide is sold under the brand names Ozempic and Wegovy.
Ahead, obesity medicine physicians and cardiologists explain how certain GLP-1 receptor agonists can potentially delay — or even prevent — devastating heart health consequences.
[READ Can Microdosing Weight Loss Drugs Like Ozempic Help You Lose Weight?]
How GLP-1 Drugs Work to Protect Your Heart
GLP-1 receptor agonists improve cardiovascular health primarily by addressing the two main drivers of heart disease: diabetes and obesity.
“When we look at a person’s whole health, it’s clear how Type 2 diabetes, obesity and heart disease are connected,” says Dr. Lisa M. Ferreira, a family and obesity medicine physician for AdventHealth Medical Group.
GLP-1s protect the heart through multiple, overlapping pathways, including:
— Reduced chronic inflammation and plaque buildup. This type of inflammation can significantly contribute to atherosclerosis (plaque buildup in arteries). GLP-1 receptor agonists can reduce inflammatory markers, which include high-sensitivity C-reactive protein and cytokines that drive inflammation in the body.
— Enhanced blood vessel function. Specifically, GLP-1s support the endothelium lining of blood vessels. This enables arteries to dilate properly and improves circulation. When blood vessels are healthy, they are less susceptible to blood clot formation and damage.
— Weight loss. The link between obesity and cardiovascular disease is clear, and these drugs can help support sustained weight loss while also targeting visceral fat, a known contributor to cardiovascular disease.
— Improved insulin resistance. Similarly, there’s a clear link between Type 2 diabetes and cardiovascular disease. By addressing high blood sugar levels and improving insulin resistance before diabetes even develops, GLP-1s can help lower your cardiovascular disease risk.
— Reduced blood pressure. Some people may only witness slight reductions in systolic blood pressure, but they’re still considered “clinically meaningful.” Even lowering this part of your blood pressure by 2 to 5 mmHg can significantly reduce your long-term cardiovascular risk.
— Lower cholesterol. GLP-1s target key cardiovascular risk factors by lowering bad cholesterol (LDL) and triglycerides while elevating healthy HDL levels.
“The cardiovascular benefit was largely independent of the amount of weight loss achieved,” says Dr. Harlan Krumholz, a cardiologist and Harold H. Hines Jr. Professor of Medicine at Yale School of Medicine. “That suggests the drugs may have additional direct effects on vascular biology and inflammation, beyond simply reducing body weight.”
To be clear, GLP-1s are not yet meant to replace statins or blood pressure medications, but they are becoming an important addition to preventive cardiology, especially for high-risk patients.
[READ: Exercising on GLP-1s: How to Stay Safe and Healthy]
GLP-1 Medications Approved for Heart Health: What the Trials Show
Here is a breakdown of GLP-1 medications currently approved by the FDA to help prevent serious cardiovascular events in adults with heart disease:
[CHART]
Some GLP-1–based medications are also approved to treat conditions that commonly occur in people with cardiometabolic risk factors that increase the likelihood of heart disease, including:
— Obesity-related sleep apnea
— Metabolic dysfunction-associated steatohepatitis, a progressive liver disease
[READ: Does Medicare Cover GLP-1 Weight Loss Drugs Like Ozempic and Zepbound?]
Who Qualifies for GLP-1s for Cardiovascular Risk Reduction?
It depends on which GLP-1 receptor agonists you’re taking, but generally speaking, they are approved for MACE reduction in those who have:
— Type 2 diabetes and have higher cardiovascular risk
— Obesity or are overweight with established cardiovascular disease or cardiovascular disease-related conditions
— A history of severe peripheral artery disease, myocardial infarction and stroke
“Anyone who’s interested in cardiometabolic health and has obesity should consider these medications not just for how they’ll look, but how long they can live and how healthy they can be,” Krumholz says. “I actually don’t think of them as weight loss drugs. I think of them as heart health drugs.”
Who Should NOT Take GLP-1s (Contraindications and Warnings)
GLP-1 receptor agonists are not one-size-fits-all — even in those who have qualifying conditions. People who should steer clear of these drugs include those who have:
— Personal or family history of medullary thyroid cancer or MEN2 syndrome
— History of pancreatitis
— Severe gastrointestinal motility disorders, such as gastroparesis
— Are pregnant, trying to conceive or breastfeeding
— Very low BMI
— Frailty in older adults
— Active gallbladder disease
— Heart failure with reduced ejection fraction (specifically below 30%)
Common and Serious Side Effects of GLP-1s and How to Manage Them
No matter why you’re taking GLP-1s, the side effects stay the same.
GLP-1 side effects include:
— Nausea
— Vomiting
— Diarrhea
— Filling up easily when eating meals
— Bloating
— Headaches
— Skin reactions at the injection site
A common misconception about GLP-1 use is that you’ll automatically lose muscle. While it’s true that can happen, you can prevent that by eating adequate amounts of protein and keeping up with consistent strength-training exercise.
While not nearly as common, there are several serious side effects linked to these drugs. These rare risks include:
— Pancreatitis
— Diabetic retinopathy complications
— Gallbladder issues
— Kidney injury
9 Essential Questions to Ask Your Doctor About GLP-1s for Your Heart
Here’s what experts say you should ask your doctor before starting a GLP-1 drug
:
1. Am I a candidate based on my current cardiovascular history?
2. Do I have cardiometabolic disease?
3. Can I potentially benefit from these drugs?
4. How will this interact with my current blood pressure or cholesterol meds?
5. If these GLP-1 medications work, can I reduce my diabetes, hypertension or cholesterol medications?
6. What is the long-term plan for maintenance?
7. Will my insurance cover this for heart health?
8. Can I come off GLP 1 medications after a few years if I incorporate lifestyle modifications, improve my dietary habits and exercise regularly?
9. How do I manage potential muscle loss? Will protein supplementation and exercise help? How much of both are needed?
Bottom Line
Emerging research is showing a clear link between GLP-1 receptor agonist use and reduction of major adverse cardiovascular events in those with established cardiovascular disease-qualifying candidates.
“This class of drugs may potentially rise to be amongst the top five medical breakthroughs of all time,” Kasi says.
That said, these drugs only work if you put the effort in. Eating a healthy diet and exercising often are key to reaping the most health benefits. Talk to your doctor if you have any concerns about your cardiovascular health and how GLP-1s may help you.
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GLP-1 Drugs for Heart Health: Benefits, Side Effects & Who Should Take Them originally appeared on usnews.com