ABCs of heart disease prevention now include the letters GLP for some patients

Cardiologist Matt Belanger, M.D., has long known about the ABCs of heart disease prevention. “A is for assess risk/antiplatelet therapy. B is for blood pressure. C is for cholesterol. D is for diet/diabetes.”
But for some heart patients, the letters G, L and P have become important as well. “The GLP-1 receptor agonists initially were developed for diabetes, improving blood sugar control,” Belanger said.

“And then they found that they worked for weight loss. And then more recently, they’ve become one of the heart medications that we use for a variety of reasons,” the MUSC Health Cardiology prevention specialist said.

GLP stands for glucagon-like peptide. GLP-1 medications work by mimicking a natural hormone, making people feel full longer and reducing feelings of hunger and cravings. They lose weight, which has health benefits of its own.

“But the result seems to extend beyond just those mechanisms and has effects on inflammation, decreasing systemic inflammation and stabilizing plaque in the arteries,” Belanger said.

“In particular, when we think about atherosclerotic cardiovascular disease or someone who’s had a heart attack before or a stent placed or has coronary artery plaque buildup, we consider GLP-1s.”

A big study called the SELECT trial found that semaglutide, a type of GLP-1 sold under the brand names Ozempic, Wegovy and Rybelsus, reduced the number of major cardiovascular events in people medically classified as overweight or obese who also had cardiovascular disease but not diabetes.

The researchers say semaglutide improved several factors linked to heart health, including blood pressure; waist size; glycemic control; kidney health; lipid levels, which include fat and cholesterol; and levels of C-reactive protein, which rises when there’s inflammation.

And Belanger said GLP-1s may help with other heart conditions in addition to the ones he cited earlier. “There have been some studies for patients who have heart failure with preserved ejection fraction. We have other medications that are first line, but it can be considered in patients who have obesity and heart failure with preserved ejection fraction. It’s been shown to improve symptoms and may improve outcomes.”

GLP-1s can cause side effects, including diarrhea, nausea and vomiting and may also cause other issues such as increases in heart rate, inflammation of the pancreas and gallbladder and kidney problems, according to CVS.com.

But for some people, the benefits outweigh the potential downsides. “I think the recognition of this has really reached a lot of the mainstream public. And so people are often even asking me about it,” Belanger said.

“It’s been kind of incredible to see how a medication that was thought of as beneficial for diabetes is reducing heart risk. It’s been a big shift in terms of how beneficial it can be.”