What GLP-1 Medications Are
GLP-1 receptor agonists — including semaglutide (Ozempic, Wegovy), tirzepatide (Mounjaro, Zepbound), liraglutide (Victoza, Saxenda), and others — were originally developed to treat type 2 diabetes. They work by mimicking a natural gut hormone that stimulates insulin release, slows gastric emptying, and reduces appetite.
Over the past several years, these medications have become widely prescribed for weight loss in patients with and without diabetes. They have also become a subject of significant cardiovascular research — and the results have been notable.
The Cardiovascular Evidence
Multiple large randomized trials have now demonstrated that GLP-1 medications reduce the risk of major cardiovascular events — specifically heart attack, stroke, and cardiovascular death — in patients with established heart disease or high cardiovascular risk. The SELECT trial, published in 2023, showed that semaglutide reduced major cardiac events by 20 percent in overweight and obese patients with prior cardiovascular disease, even without diabetes.
These are meaningful, consistent findings. The benefit appears to come from a combination of weight loss, blood pressure reduction, improved blood sugar control, direct anti-inflammatory effects on blood vessels, and possibly direct cardiac effects independent of weight change. Research is ongoing to untangle exactly how much each mechanism contributes.
What This Means for Cardiac Patients
For patients with established coronary artery disease, heart failure with preserved ejection fraction, prior heart attack or stroke, or high ASCVD risk, the cardiovascular evidence for GLP-1 medications is strong enough that these drugs have moved from diabetes medications to genuine cardiovascular drugs in practice.
The 2024 ACC/AHA guidelines now include GLP-1 receptor agonists as a consideration for cardiovascular risk reduction in patients with obesity-related cardiovascular disease. If you have been prescribed one of these medications, or if you are asking about them, your cardiologist can help contextualize the evidence relative to your specific situation.
Important Considerations and Limitations
GLP-1 medications are not appropriate for everyone. They are generally avoided in patients with a personal or family history of medullary thyroid cancer or MEN2 syndrome, and they carry a small risk of pancreatitis. Gastrointestinal side effects — nausea, vomiting, diarrhea — are common especially when starting or increasing dose, and are a leading reason patients discontinue the medication.
These medications are also expensive and coverage varies significantly. Patients who stop taking them often regain weight, as the underlying mechanisms driving appetite and weight do not change permanently. The decision to start, continue, or stop a GLP-1 medication should be made with a clear understanding of the goals and a realistic plan for long-term use.
Questions for Your Cardiologist
If you are already taking a GLP-1 medication, let your cardiologist know — both because it affects your cardiovascular risk profile and because dosage changes, side effects, or interactions may be relevant to your cardiac care.
If you are interested in starting one, your cardiologist can help evaluate whether the cardiovascular evidence supports it in your case, coordinate with your primary care or endocrinologist, and monitor for any cardiac changes as you start. Weight loss, blood pressure improvements, and metabolic changes from these medications can all affect how we manage your other cardiovascular conditions.
Medical Disclaimer
This article is for general patient education only and does not constitute medical advice. Always consult your physician before making changes to your medications, lifestyle, or care plan.