By now, you know someone using GLP-1 receptor agonists (GLP-1s) or are considering trying them yourself. While developed for managing type 2 diabetes, many people are also finding them helpful for weight management goals. 

Beyond these two uses, growing evidence highlights cardiovascular benefits. Recent studies have shown that GLP-1s can reduce cardiovascular risks, improve heart function, and address factors contributing to heart disease. 

Understanding this connection is vital for leveraging the full potential of GLP-1s and heart health optimization. However, GLP-1s aren’t a replacement for a heart-healthy, nutritionally adequate diet, exercise, and other lifestyle habits. 

What Are GLP-1 Receptor Agonists?

GLP-1s are medications that mimic the action of glucagon-like peptide-1 (GLP-1), a naturally occurring hormone in your body. They play a key role in regulating blood sugar, especially for people with type 2 diabetes. By supporting your body’s natural processes, GLP-1s can help maintain stable glucose levels and prevent dangerous spikes (and drops). 

GLP-1s work through a few main mechanisms:

• Slowing gastric emptying: They make food leave the stomach more slowly, promoting a steady release of glucose into the bloodstream.
• Stimulating insulin secretion: They enhance pancreatic insulin production in response to meals, ensuring that blood sugar is effectively managed.
• Reducing glucagon levels: By suppressing glucagon, a hormone that raises blood sugar, GLP-1s help prevent unnecessary glucose production by the liver.

Common GLP-1 Drugs and Their Uses

Semaglutide

• Ozempic: FDA-approved for type 2 diabetes, helping improve blood sugar levels and reducing the risk of major cardiovascular events in adults with diabetes and established heart disease.
• Wegovy: FDA-approved for chronic weight management in individuals 12+ with obesity or overweight and at least one weight-related condition (like hypertension or type 2 diabetes).

Liraglutide

• Victoza: FDA-approved for type 2 diabetes in individuals 10+. It also reduces the risk of major cardiovascular events in adults with type 2 diabetes and CVD.
• Saxenda: FDA-approved for weight management in individuals 12+ with obesity or overweight, similar to Wegovy, but at a different dosage.

Dulaglutide

• Trulicity: FDA-approved for type 2 diabetes to improve blood sugar levels and reduce the risk of major cardiovascular events in adults with both diabetes and established cardiovascular disease.

Potential GLP-1 and Heart Health Benefits

Beyond impacts on blood sugar control and weight management, research shows that GLP-1s offer benefits for heart health. 

They have been shown to reduce the risk of major adverse cardiovascular events (MACE), including heart attacks and strokes, particularly in people living with type 2 diabetes and who have pre-existing heart disease.

Reduction in Cardiovascular Events

Large clinical trials have shown that GLP-1s can lower the risk of MACE by as much as 13-26%, suggesting they provide direct cardioprotective effects, potentially reducing inflammation, improving blood vessel function, and supporting heart health in high-risk populations.

Indirect Benefits Through Weight Loss and Blood Pressure Management

GLP-1s also contribute to cardiovascular health indirectly by promoting weight loss and reducing blood pressure. Excess weight and hypertension are significant risk factors for heart disease, and GLP-1s help by curbing appetite, encouraging fat loss, and improving metabolic parameters.

By tackling multiple aspects of cardiovascular risk, GLP-1s are emerging as a promising tool in heart health interventions. But again, that’s what they are—a tool to be used with science-based nutrition, exercise, and other healthy habits that support cardiometabolic wellness. 

GLP-1s in Preventing Heart Disease

There are a few ways in which GLP-1 receptor agonists may help address some key risk factors and support overall improvements in cardiovascular health.  

Targeting Key Risk Factors

GLP-1 agonist heart disease benefits include combating obesity, high blood pressure, and inflammation—three significant contributors to CVD. By promoting weight loss through appetite suppression and satiety, they reduce the overall strain on the cardiovascular system. 

Plus, they can help reduce high blood pressure and have anti-inflammatory properties that help protect your blood vessels and heart.

Improving Lipid Profiles

GLP-1s can also positively impact lipid profiles, such as reducing high LDL, a major risk factor for atherosclerosis—a condition that narrows and stiffens your blood vessels, increasing the likelihood of having a heart attack or a stroke. 

Enhancing Endothelial Function and Vascular Health

The endothelium is a thin layer of cells lining blood vessels that play a critical role in maintaining vascular health. 

According to in vitro (lab) studies, GLP-1s enhance endothelial function by boosting the production of nitric oxide (NO), helping to relax blood vessels and promote better blood flow. They can also help reduce oxidative stress and inflammation which are harmful to vascular health.

Clinical Evidence & Key Studies

While there’s a variety of research being done on GLP-1 cardiovascular benefits, there are two pivotal trials I want to highlight: 

LEADER (Liraglutide)

Published in 2016, the LEADER trial evaluated the cardiovascular effects of liraglutide in patients with type 2 diabetes who were at high risk for cardiovascular events (like heart attack and stroke). The trial lasted approximately 3.8 years and included 9,340 participants.

Over this period, the study demonstrated a significant 13% reduction in major adverse cardiovascular events (MACE) with liraglutide, including nonfatal heart attack, nonfatal stroke, and cardiovascular death, compared to placebo. 

Liraglutide also showed benefits in reducing cardiovascular-related mortality, marking it as a key therapy for improving heart health in people with diabetes and pre-existing cardiovascular risks.

SUSTAIN-6 (Semaglutide)

Also published in 2016, the SUSTAIN-6 trial looked at the cardiovascular safety of semaglutide in patients with type 2 diabetes at higher cardiovascular risk. This trial lasted approximately 2.1 years and included 3,297 participants.

At the end of the study, researchers reported a 26% reduction in MACE, particularly nonfatal stroke and nonfatal heart attack with semaglutide. Semaglutide also showed positive effects on weight loss and blood pressure. 

A post-hoc analysis of SUSTAIN 6 published in 2019 found that once-weekly semaglutide vs placebo reduced the risk of MACE in all participants in the trial, regardless of gender, age, or baseline CV risk.

Considerations

While GLP-1s can be a promising heart health tool for some, they’re not appropriate for everyone. Research suggests they provide the most benefit for people with existing heart disease, including heart failure with preserved ejection fraction (HFpEF), or who have type 2 diabetes and a higher risk of cardiovascular events. 

Still, even though GLP-1s have demonstrated success in glucose control and weight management, more long-term large trials are always needed, especially for cardiovascular health.   

Potential Limitations and Risks

Like any medication, GLP-1s come with potential downsides, like:  

• Possible side effects: For some people, GLP-1s may cause digestive issues like nausea, vomiting, diarrhea, constipation (which can put extra strain on the heart), acid reflux (which can be a source of inflammation), reduced appetite, headaches, lightheadedness, or injection site reactions. If you take diabetes medication, adding a GLP-1 may make you more susceptible to hypoglycemia.
• Potential vision-related complications: While more research is needed, there are some concerning studies coming out about a possible association between GLP-1s and a condition called nonarteritic anterior ischemic optic neuropathy (NAION). Personally, I’ve seen individuals eating only one meal per day on GLP-1s, setting themselves up for nutrition deficiencies—such as lack of vitamin A, which is essential for night vision and eye health. This is just another example of how critical it is to prioritize science-based nutrition on (and off) a GLP-1 medication. 
• Incorrect dosing: I’ve found that some people on GLP-1s have been given inappropriate doses, often from compound medspas that aren’t being provided in a true, personalized medical setting. This means you could be getting too much or too little, which influences how successful the medication is as well as your risk of potential adverse effects.

• High costs and accessibility challenges: GLP-1s are often expensive, ranging from $900 to $1,500 per month without insurance. While some plans cover GLP-1s for type 2 diabetes, coverage for weight loss or other off-label (non-FDA-approved) uses is often limited, depending on the plan and medical necessity.
• Misunderstood commitment: GLP-1s are designed to be long-term drugs, but some people see them as a temporary stepping stone to quit once they achieve their desired weight. This highlights the importance of not leaning on GLP-1s alone, instead using them alongside heart-healthy nutrition and lifestyle habits. 

Finally, it’s essential not to overlook the need for personalized medicine. While GLP-1s can have positive effects, not everyone responds equally. For example, I had a few clients who gained weight despite it being an appetite suppressant and reducing caloric intake. I also had a client with severe diarrhea for several months, and all her doctor had to say was, “This will pass.” 

Bottom line here? GLP-1s aren’t for everyone—personalization, science-based nutrition, and a team approach are key. 

GLP-1s Cardiovascular Benefits: What We Know

GLP-1s can benefit blood sugar control, weight management, and cardiovascular health. However, they’re not a substitute for preventive health, including science-based nutrition proven to help lower your CVD risk. Weighing individual risks and benefits is also important, as unwanted side effects of these drugs shouldn’t be ignored. 

Personally, I think everyone on a GLP-1 should be working with a dietitian (ideally, meeting with them before starting one), to ensure proper nutrient consumption and avoidance of the common side effects. 

If you’re seeking answers about your heart health, including getting your risks under control, learn about my group coaching program and 1:1 counseling. You can also schedule 

complementary 15-minute discovery call here.

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