According to the Centers for Disease Control and Prevention, 1 in 5 U.S. adults are living with obesity. That number has been steadily increasing for the last several decades, coinciding with most Americans getting less exercise and eating more processed foods.
Obesity alone is a risk factor for heart disease, but it can also cause other risk factors, such as high blood pressure, high cholesterol and diabetes. In the past, people with obesity primarily received treatment for the medical conditions they experienced as a result of the obesity.
Today, the underlying health issue—obesity itself—can increasingly be treated successfully, helping to alleviate or even reverse many heart health conditions or risk factors.
Development and Evolution
So-called “obesity drugs” didn’t actually start as obesity treatments at all. The first GLP-1 receptor agonist was approved by the FDA in 2005 to treat Type 2 diabetes.
This class of medications works by mimicking the effects of a hormone known as glucagon-like peptide-1, or GLP-1.
GLP-1 is made by the small intestine and has several key functions:
- Triggers the pancreas to release insulin
- Blocks glucagon production
- Slows stomach emptying
- Increases satiety after eating
GLP-1 receptor agonists attach to a cell receptor in the body and perform the same functions as GLP-1, helping the body moderate blood sugar and slow digestion. These medications were used for years to treat Type 2 diabetes, but in 2014, the first GLP-1 medication was approved solely for the treatment of obesity.
Common Obesity Medications
While GLP-1 medications have been around for a while, they’ve been in the spotlight over the past few years. Multiple obesity drugs are now available in the United States, including:
- Exenatide, marketed as Byetta and Bydureon
- Liraglutide, marketed as Victoza
- Semaglutide, marketed as Ozempic or Wegovy (injections) or Rybelsus (a tablet)
- Tirzepatide, marked as Mounjaro or Zepbound
Unlike the other medications, which are GLP-1 receptor agonists, tirzepatide is a dual GLP-1/GIP receptor agonist. It works by activating both the GLP-1 receptor and a GIP receptor.
Some of these medications are used to treat Type 2 diabetes, while others are marketed for the treatment of obesity.
Obesity Medications’ Effects on the Heart
Obesity drugs, or their counterparts used to treat diabetes, can have a profound effect on the body because of the way they disrupt the digestive process. Essentially, they hit the reset button on how the body handles insulin, while also affecting how the body processes food.
How does that impact the heart? Research in the past few years has found a connection between the heart, the kidneys, and metabolism. Last year, the American Heart Association coined this systemic disorder as “cardiovascular-kidney-metabolic syndrome,” or CKM for short.
This recognizes the fact that different systems in the body work collaboratively—and on the flip side, when one is damaged, it can affect others. When obesity drugs change how your body digests food and manages blood sugar, your heart reaps the benefits:
- Improved blood pressure
- Less inflammation
- Lower cholesterol
- Reduced plaque buildup in arteries
- Weight loss
These benefits add up to improved heart health. In fact, a study earlier this year found that those using Wegovy had a 20% lower risk of experiencing a cardiac event. Subsequently, that medication has been approved to reduce the risk of cardiovascular death and stroke in those with heart disease who are overweight or obese.
Impact on Cardiology Practice
Innovative new medications like GLP-1s are changing the face of heart health. Rather than focusing on treating heart health issues as they emerge, doctors are focusing on preventing those problems in the first place.
When you can help people lose weight by changing the way the body digests food, you can lower or even eliminate the risk associated with obesity. We now also know that these medications lower other risk factors related to poor cardiovascular health in addition to promoting weight loss.
With that said, however, obesity drugs aren’t a solution for everyone. In some cases, they may not promote weight loss, or they may cause side effects that diminish quality of life. There’s also an economic component—while the GLP-1s used to treat Type 2 diabetes are increasingly covered by insurance, obesity-specific drugs often aren’t and can be quite expensive.
What’s ahead for the future of these medications and their role in improving heart health? Further research is needed to determine how they can most effectively be used to prevent cardiac events, who they’re appropriate for, and whether even better options exist.
Heart Care at University Health
Ask your provider how weight loss medications may be impacting your heart, and learn more about heart care at University Health.
