Beyond weight loss: Could GLP-1 agonists improve your heart health?

Heart Health

by Javed Butler, MD

Jun 13, 2024

Could a popular weight loss medication help lower your risk of heart attack or stroke? You’ve likely heard the buzz around a weight loss drug called semaglutide, a type of GLP-1 agonist used to treat type 2 diabetes and obesity.

But its benefits could extend beyond weight loss—in fact, new research shows semaglutide could lower people’s risk for adverse cardiac events by as much as 20%.

For people who are obese and at high risk of recurrent heart attack or stroke, GLP-1 agonists like semaglutide can be a game-changer. But what are they, how do they work and are they the right choice for you?

Here’s what you need to know.

GLP-1 for weight loss

GLP-1 agonists are effective at causing weight loss because they mimic a hormone in your body called GLP-1 (glucagon-like peptide-1). This helps control blood sugar levels, reduce appetite and improve heart health.

Weight loss medications are nothing new, but what makes GLP-1 agonists different is how they influence appetite and satiety. Other weight loss drugs are designed to increase the number of calories burned, but they don’t address the increase in appetite that many people feel because they’re burning calories. Because of this, many people end up eating more food and therefore don’t lose as much weight or can’t keep the weight off.

GLP-1 agonists like semaglutide are more effective because they do several things:

  • Increase insulin secretion, the process where the pancreas releases more insulin into the bloodstream.
  • Decrease glucagon secretion. Glucagon is a hormone that raises blood sugar levels. Decreasing glucagon secretion helps to lower blood sugar levels.
  • Improve glucose utilization, which helps the body use sugar more efficiently for energy.
  • Delay gastric emptying and how quickly food leaves the stomach, making you feel full longer.
  • Decrease appetite, reducing the desire to eat more.
  • Increase satiety, making you feel fuller for longer.

The biggest difference is those last two points—these drugs work in the area of the brain called the central hypothalamus to decrease appetite and increase satiety. That means you don't feel as hungry and you feel full faster, making it easier to lose weight and maintain that weight loss.

Semaglutide for heart health

These drugs were originally developed for Type 2 diabetes and weight loss. But new research shows that people who are obese and have cardiovascular disease not only experience weight loss, but also a decrease in their risk of heart attack, stroke and death.

It’s important to understand that semaglutide is marketed under two different names for two different doses. It’s the same drug, but they come in different doses for different uses—one for Type 2 diabetes, and one at a higher dose for weight loss and now for lowering heart disease risk in obese people.

Semaglutide works to lower risk of heart attack, stroke, and death from heart disease by decreasing the adiposity, or accumulation of fat, in your body. Adiposity can be systemic, impacting the health of your entire body. Excess fat that we carry in our belly or thighs can lead to chronic conditions such as:

  • Inflammation
  • Oxidative stress (a condition where your body has too many molecules known as free radicals)
  • High blood pressure 

Adiposity can also be localized around a certain organ, like the heart, raising your risk for organ-related issues.

Bottom line: the driving factor for heart disease and cardiovascular events is excess fat. For people who are obese, drugs like semaglutide that cause significant fat loss can be lifesaving, reducing the risk of heart attack or stroke and putting people on the path to better well-being.

Should you take GLP-1 agonists?

So, are GLP-1 agonists a good option for you? If you are obese or overweight and at risk for cardiovascular disease, you may want to consider talking to your doctor about medication options like semaglutide.

Nothing in medicine is one-size-fits-all, so it’s important to have a conversation with your doctor about your individual risk factors, lifestyle and health history so you can make the best decision for your future health. Taking this drug does not mean your lifestyle doesn’t matter. It’s still important to eat well, exercise and take care of yourself; these are fundamental to improving your health.

To have the biggest impact on your health, medications should be used in combination with heart-healthy lifestyle changes. The less dependent you are on medication, the better off you’ll be.

If you’re looking to improve your heart health, the following are good steps:

  • Eat a diet low in salt.
  • Manage your caloric intake.
  • Exercise regularly.
  • Don’t smoke.
  • Address individual risk factors (such as high blood pressure, diabetes and high cholesterol).

One of the best things you can do to lose weight is exercise. But the more overweight you are, the more difficult it is to exercise, right? That’s one benefit of these weight loss drugs—for many people, it helps get them over that hump, so they lose some weight and are then able to exercise and live a more active lifestyle.

The same goes for diet as well. Many people who struggle with obesity feel hungry all the time. Semaglutide may help reduce their appetite, making it easier for them to make healthier food choices and achieve the weight loss needed to improve their heart health.

GLP-1 side effects

There are side effects and risks to keep in mind when starting any new medication. That’s why talking to a physician about your individual concerns and health history is important.

GLP-1 agonists like semaglutide should not be taken by people who have a history or family history of thyroid cancers or endocrine neoplasia, any allergies to the ingredients, or previous allergic reaction or angioedema due to similar drugs.

Potential side effects include:

  • Can cause pancreatitis
  • Can cause gallbladder disease
  • Hypoglycemia (low blood sugar)
  • Digestive issues (nausea, vomiting, diarrhea, abdominal pain)

If you’re worried about side effects, talk to your doctor about how to introduce the medication gradually and slowly increase your dose over time to help lessen any side effects you experience.

The future of weight loss research

We’re continuing to study how these medications can be used to optimize people’s well-being and manage various health risks.

While this is an important step forward in improving quality of life for obese people with heart conditions, we’re now looking to prevention—why couldn’t we use medications like this to prevent heart issues in the first place? But this needs to be tested.

Research is also exploring how these drugs can help manage other heart conditions like heart failure, as well as issues impacting other organs like the kidney and liver. The good news is, lowering excess fat can have powerful effects throughout the body, meaning there are a lot of potential uses for these medications.

If you have questions about whether weight loss drugs like GLP-1 agonists are right for you, talk to your doctor or cardiologist. Or find a doctor near you today.

About the Author

Javed Butler, MD, is a cardiologist and president of the Baylor Scott & White Research Institute.

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