Are Weight Loss Drugs Good for Your Heart?

Many people have started taking weight loss drugs in the last few years. An endocrinologist from Keck Medicine of USC talks about how these can affect your heart health.

Many people in recent years have started taking GLP-1 agonist drugs like semaglutide (marketed under the brand names Ozempic and Wegovy) or tirzepatide (marketed under the brand names Mounjaro and Zepbound) for weight loss. Oftentimes, people who are overweight or obese might also struggle with cardiovascular problems or bad heart health.  

“Excess body fat can increase the risk of high blood pressure, high cholesterol and diabetes, which all increase the risk for cardiovascular disease,” says Alyssa Dominguez, MD, an endocrinologist at Keck Medicine of USC. “Weight loss drugs can help reduce excess body fat. Through weight loss, most of these medications are beneficial for heart disease, but there are some special considerations for certain drugs.”  

Heart health benefits of GLP-1 agonists in people without diabetes 

Recent studies have shown that GLP-1 agonists might also reduce the risk of cardiovascular disease. The SELECT clinical trial in 2023 showed that semaglutide reduced the risk of heart attack, stroke and death from cardiovascular causes in both overweight and obese people without diabetes by almost 20%. This study built on earlier studies that showed these benefits only in people with diabetes. 

“This trial made big news when it came out as it was one of the first trials to show that the benefits that GLP-1 receptor agonists confer to patients with diabetes also extend to those with overweight or obesity without diabetes,” Dr. Dominguez says. It led the Food and Drug Administration (FDA) to approve use of this drug to reduce the risk of cardiovascular death, heart attack and stroke in adults who are obese or overweight and have cardiovascular disease.

Other studies are also showing similar positive effects with Eli Lilly’s GLP-1 drug, tirzepatide, which is a dual GLP-1/GIP receptor agonist, marketed under the name Zepbound when used for weight loss. A November study published in The New England Journal of Medicine found that this drug benefited people with a type of heart failure called preserved ejection fraction and obesity. 

Heart health benefits of GLP-1 agonists in people with diabetes 

When it comes to these weight loss medications in people with diabetes, there is even more robust data supporting heart health benefits, Dr. Dominguez says. There are published trials for semaglutide (Ozempic), dulaglutide (Trulicity) and liraglutide (Victoza) showing cardiovascular benefit, she says. And since tirzepatide works with a similar mechanism of action and is showing even greater reduction in weight and A1c (a marker of diabetes), tirzepatide will likely show a similar benefit, but trials are still ongoing since the drug is newer to the market, she says. 

“People who have diabetes and cardiovascular disease should also consider the use of a sodium-glucose cotransporter 2 (SGLT2) inhibitor, as this class of medication has also shown benefit in individuals with preexisting cardiovascular disease and type 2 diabetes,” Dr. Dominguez says. 

Other weight loss drugs and heart health 

Regarding other weight loss medications, phentermine would not be advised for people with a history of cardiovascular disease, Dr. Dominguez says. Phentermine is also an appetite suppressant that is sometimes used for weight loss, but it can cause heart palpitations, an abnormally fast heart rate and other heart complications.  

“Of note, a study published in 2018 in The Journal of Clinical Endocrinology and Metabolism did not show an increase in the rate of major adverse cardiovascular events in individuals taking a combination of phentermine and topiramate,” Dr. Dominguez says. “This combination of medications is marketed under the brand name Qsymia and has the highest percentage of weight loss outside of the GLP-1 receptor agonist/GLP-1 and GIP receptor agonist family.”

Current data does not support an increased risk of major adverse cardiovascular events with naltrexone/bupropion either, she says.

Losing weight overall can have many good implications for your overall health, including your heart. While some older weight loss drugs have not been shown to reduce cardiovascular events, newer medications, such as GLP-1 receptor agonists, have been showing heart health benefits. The exact mechanisms of how this happens are still being researched, but researchers think it might be because they reduce inflammation and improve blood vessel function. If you think you might be a candidate for a weight loss medication for your heart health, speak to your doctor.

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