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GLP-1 RA medications are making headlines again, this time for success in a large-scale clinical trial focusing on a new health target: cardiovascular disease. The results of this research may mean that cardiologists will soon have another addition to their tool kit against heart disease, the most common cause of death in the U.S.
Marketed under brand names such as Wegovy® and Ozempic®, GLP-1 RA drugs first came to market 20 years ago to help people living with Type 2 diabetes manage their blood sugar levels. In 2014, the Food and Drug Administration (FDA) first approved the use of GLP-1s for weight loss, and the results have been nothing short of transformative for many patients.
We’re now looking forward to the FDA approving the GLP-1 class of drugs for more heart-related reasons. As a preventive cardiologist, I want all patients with heart conditions and their primary care doctors to understand why this development is causing so much excitement – and what it might mean for treating and preventing cardiovascular conditions.
What is a GLP-1 RA medication?
GLP-1 RA is an abbreviation that stands for glucagon-like peptide-1 receptor agonist. GLP-1 is a hormone produced in the intestines that works together with a receptor to control blood sugar. When the agonist is introduced via the medication, the body responds by making more insulin.
GLP-1 RA drugs also limit the how much glucagon hormone is made in the pancreas, slow down your stomach emptying, and signal the “fullness” center in your brain that you’re no longer hungry. That’s why they’re such effective treatments for diabetes and weight loss.
Related reading: How GLP-1 RA Medications Can Help Manage Diabetes and Weight Loss
How do GLP-1 drugs affect the heart?
Research over nearly a decade has shown that the GLP-1 drug semaglutide can lead to remarkable impacts on cardiovascular function in patients with Type 2 diabetes and/or overweight and obesity.
Studies have shown these drugs lower the risk of a cardiac event such as a heart attack or stroke. Some important measurements of heart health showed noticeable improvements:
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Lower A1C
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Lower blood pressure
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Lower inflammation
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Lower total cholesterol, LDL-C, and triglycerides
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Lower weight
GLP-1s have also proven to be effective in helping reduce cholesterol plaques associated with atherosclerosis and improving several factors in kidney function that affect the heart.
Related reading: More Than a Number: Bariatric Surgery, GLP-1 Medications and Tools to Treat Obesity.
What does the latest research show?
In late 2023, researchers published the results of the Phase III SELECT trial that investigated the use of semaglutide in patients with overweight and a previous history of cardiovascular disease – but no diagnosis of diabetes.
This large study, which included more than 17,500 patients, showed that adding semaglutide to their standard care significantly reduced the risk of heart attack, stroke, or death by cardiovascular disease. In fact, the SELECT participants who took semaglutide for more than 3 years lowered their risk of these major adverse cardiovascular events by 20%.
More new studies are confirming these results with even greater clarity, demonstrating that the cardiovascular benefits occur regardless of the starting weight or amount of weight loss.
We are also glad to see that the cardiovascular improvements shown in the SELECT trial were consistent across age, gender, race, body size, and geographic region. Participants in smaller, more limited research studies tend to be White and financially secure. This new data tells us that GLP-1s may be beneficial in reducing the burden of heart disease regardless of background or income.
Related reading: Research Identifies Gaps—and Opportunities—in Heart Disease Care Among Older Women.
Do all types of GLP-1 drugs have the same heart benefits?
The injectable weight-loss drug Wegovy is the only medication currently approved for cardiovascular indications in patients with overweight or obesity and existing cardiovascular disease.
The only known cardiac-related side effect of GLP-1 drugs is the heart rate tends to go up. After nearly 20 years of data, we can confidently say that there are no significant adverse cardiovascular complications.
The most common side effects for patients taking a GLP-1 are gastrointestinal issues. You might experience nausea, cramping, diarrhea, or digestive problems when you first start taking the weekly medication. These symptoms typically go away within a few days after the injection and become milder or disappear the longer you take the medication. We encourage patients to stick with it through these side effects, because the long-term outcomes are generally worth the initial discomfort.
While researchers are still studying the exact mechanisms that cause these benefits, my colleagues and I are hopeful that more GLP-1s will be soon approved for treating and preventing cardiovascular disease for patients that are at high risk.
These findings are likely just the tip of the iceberg. There are many new medications in the GLP-1 category under development that are even more potent than what we have now.
Keeping your heart healthy can be hard. We can help.
While medications like GLP-1s aren’t approved for all heart patients, you can talk to your doctor about the possibility of adding a GLP1 to your current care plan.
New medications are just one way we tackle cardiovascular disease. At MedStar Health, we focus on caring for the whole person. Your cardiologist or primary care physician can connect you to our colleagues in endocrinology, bariatric medicine, and other specialties. You can also take advantage of health and wellness resources such as smoking cessation, nutritional counseling, and exercise programs.
