A new University College London study featuring 17,604 participants age 45 and up discovered that semaglutide — a GLP-1 agonist found in weight-loss drugs like Ozempic and Wegovy — decreases the risk of major adverse cardiovascular events, like a heart attack and stroke, in patients who were of a higher weight or dealing with obesity. These patients also had cardiovascular disease, but didn’t have diabetes (the condition semaglutide is primarily used for), and early on in the study, their MACE risk decreased regardless of how much weight they lost or their waist circumference. Their results were compared with those of participants taking a placebo.
After 20 weeks, a reduction in waist size was associated with a greater reduction in MACE compared to weight loss. However, waist circumference alone accounted for, at most, 33% of the MACE reduction, meaning that semaglutide’s cardiovascular benefits were not solely based on its impact on waist size.
This was the largest study of its kind on GLP-1s in patients with cardiovascular disease, and it found that semaglutide could have cardiovascular benefits beyond its weight-loss effects. However, side effects of these drugs also need to be considered, which further research can take into account.
In the meantime, we consulted with experts to learn more about the benefits and risks associated with GLP-1s, such as Ozempic, Wegovy and others.
What are GLP-1 agonists like Ozempic?
GLP-1 agonists, also known as incretin mimetics, are a class of medication that is primarily used to treat type 2 diabetes and, in some cases, obesity.
“The glucagon-like peptide (GLP-1) is a naturally occurring hormone in the small intestine which triggers the release of insulin from the pancreas. This process helps to regulate blood sugar levels,” said Angela Haynes-Ferere, associate professor at Emory School of Nursing in Atlanta. “The GLP-1 agonist mimics the action of this naturally occurring hormone. After eating, blood sugars will rise, and these medications cause the pancreas to release more insulin which helps to lower blood sugar.”
In addition to helping people with type 2 diabetes control their blood sugar, this medication reduces one’s appetite. It also slows the digestive process so patients report feeling full with less food intake. This results in weight loss for many users, but it varies based on many individualized factors, said Haynes-Ferere.
According to Cleveland Clinic, most of the GLP-1 agonists are available as liquid medication that needs to be injected under the skin, except one that is available in tablet form (Rybelsus).
A few generic and brand names of GLP-1 agonists, according to the Johns Hopkins Patient Guide to Diabetes, include:
- Dulaglutide, marketed as Trulicity
- Lixisenatide, marketed as Adlyxin
- Liraglutide, marketed as Victoza
- Semaglutide, marketed as Ozempic
- Semaglutide oral, marketed as Rybelsus
- Tirzepatide, marketed as Mounjaro or Zepbound (a dual GLP-1/GIP agonist)
Each brand has its own recommended dosage and frequency of intake. Some may be taken once daily, while others are used weekly. You must consult your doctor to understand what dosage and frequency best suit you.
Potential GLP-1 agonist benefits
“In addition to controlling blood sugar and reducing obesity, these medications have been shown to reduce cardiovascular risks and improve kidney function,” said Haynes-Ferere. Anecdotally, individuals are reporting reduced smoking, gambling, alcohol intake and drug use, she noted.
“Studies have shown benefits in worsening kidney disease, heart failure and obstructive sleep apnea in patients with obesity,” says Dr. Leon Jons, a weight management specialist and clinical associate professor of Internal Medicine-Endocrinology and Metabolism at Carver College of Medicine in Iowa.
According to Cleveland Clinic, other benefits of GLP-1 agonists may include:
- Lowering blood pressure
- Improving lipid disorders
- Reducing systemic inflammation
- Delaying the progression of diabetes-related nephropathy or diabetes-related kidney disease, aka DKD
These benefits not only make GLP-1 agonists effective for managing type 2 diabetes but also contribute to better cardiovascular health. However, the effect of GLP-1 agonists varies from one person to another. Always talk to your doctor to understand how GLP-1 agonists may benefit your specific condition.
GLP-1 agonists could lower blood pressure, reduce inflammation and improve kidney function.
GLP-1 agonist side effects and risks to consider
For some patients, the speed of weight loss can lead to the undesired cosmetic effect of a gaunt face (colloquially called “Ozempic face”), particularly in patients with less skin elasticity, said Haynes-Ferere. She added that regular exercise with weight training can help preserve muscle mass and maintain a healthy appearance.
The medications’ side effects are predominantly related to the gastrointestinal system — for example, nausea, constipation, diarrhea or belching. For most patients, these effects are mild and resolve over time. For some, the side effects can be severe, and patients would need to stop the medication, Jons said.
Other common side effects of GLP-1 agonists, as reported in a National Library of Medicine article, include:
- Loss of appetite
- Vomiting
- Headache
- Dizziness
- Mild tachycardia (increased heart rate)
In some cases, minor episodes of hypoglycemia may occur. “Hypoglycemia would be extremely rare and is more likely to occur in patients who are also taking other diabetes medications that can lower blood sugar too much,” said Dr. Troy Mensen, a family medicine doctor based in the Chicago area and member of the medical review board. Cleveland Clinic reports that hypoglycemia is a condition in which blood glucose levels drop below 70 mg/dL. If left untreated, it may become life-threatening. Symptoms of hypoglycemia may include shakiness, weakness, nausea, difficulty concentrating and dizziness. Consuming sugars or carbohydrates can treat hypoglycemia.
Also, doctors do not recommend GLP-1 agonists to pregnant people since it may pose a threat to the developing fetus. Consult your doctor if you’re pregnant, planning to get pregnant or are breastfeeding.
Who should take GLP-1 agonists?
Doctors primarily recommend GLP-1 agonists for type 2 diabetes and obesity. However, GLP-1 agonists are not the first choice of treatment. Metformin, an oral medication, remains the first choice for managing type 2 diabetes. However, doctors may recommend GLP-1 agonists if you:
- Cannot tolerate metformin
- Are unable to lower your blood sugar levels with ongoing medications even after three months
- Experience complications due to other conditions such as heart failure, atherosclerosis or chronic kidney disease
Cleveland Clinic reports that doctors may also recommend two GLP-1 agonists, semaglutide and liraglutide, for treating obesity. Dr. Mensen adds that tirzepatide (Mounjaro or Zepbound), a dual GLP-1/GIP agonist, may also be recommended.
“Based on the fact that each individual experience with this medication is different, the patient should work with their healthcare provider to determine the best treatment plan and goal for overall well-being,” said Haynes-Ferere.
Additionally, GLP-1 agonists such as dulaglutide, semaglutide and liraglutide have been shown to provide cardiovascular benefits. Doctors may also recommend these GLP-1 agonists to reduce the risk of heart disease.
The recommended frequency of intake for commonly prescribed GLP-1 agonists includes:
- Dulaglutide: Weekly
- Liraglutide: Daily
- Semaglutide: Weekly
- Tirzepatide: Weekly
- Semaglutide tablets: Daily
Depending on which GLP-1 agonist you take, there is a different recommended frequency.
Who should not take GLP-1 agonists?
Although GLP-1 agonists can help to effectively treat type 2 diabetes and obesity, they may not be suitable for everyone. Your doctor may avoid prescribing GLP-1 agonists if you have:
- Family history of medullary thyroid cancer: This rare thyroid cancer has been linked to the use of GLP-1 agonists in rodents. Your doctor may avoid prescribing GLP-1 agonists if you have a family history of medullary thyroid cancer.
- Multiple endocrine neoplasia syndrome type 2, or MEN2: A rare condition characterized by tumors in endocrine glands. Doctors may avoid prescribing GLP-1 agonists if you have been diagnosed with or have a family history of MEN2 since they can stimulate abnormal cell growth.
- Pregnant people: Doctors may not recommend GLP-1 agonists to pregnant people since it can pose a risk to the developing fetus.
- History of pancreatitis: Doctors most often avoid GLP-1 agonists in people with a history of pancreatitis since GLP-1 agonists may increase the risk of fatal hemorrhagic and necrotizing pancreatitis.
- Inflammatory bowel disorders or gastroparesis: GLP-1 agonists slow gastric emptying and may worsen symptoms of inflammatory bowel disorders.
GLP-1 overdoses and important info to remember
GLP-1 agonists are prescription medications and should be taken only under the supervision of your doctor. Following the recommended dosage can help to prevent overdoses. According to America’s Poison Centers, an overdose of GLP-1 often causes similar symptoms to side effects:
- Nausea
- Diarrhea
- Vomiting
- Abdominal pain
- Constipation
However, the duration of these symptoms may be longer. In severe cases, you may also experience dehydration and hypoglycemia, which may require immediate medical attention.
You must double-check the dose before taking the medication and set a reminder for the next dose to prevent the risk of overdose.
If you experience any severe side effects when taking a GLP-1 agonist, contact your doctor immediately.
When to contact a doctor if taking a GLP-1 agonist
You must contact your doctor if you’re experiencing serious side effects after using a GLP-1 agonist, such as:
- Nausea
- Abdominal pain
- Dizziness
- Increase in heart rate
- Shaking or trembling
Also, consult your doctor first if you think the medication is not working for you or if you’re considering not continuing the medication.
Additionally, scheduling regular follow-ups with your doctor while you’re on GLP-1 agonists is important. These follow-ups help monitor your blood glucose levels and determine if any dosage changes are necessary. Regular follow-ups can also help doctors monitor signs of hypoglycemia, renal disease, pancreatitis and thyroid cancer.
The bottom line
GLP-1 agonists are medications that primarily treat type 2 diabetes and obesity. However, recent studies suggest they can lower blood pressure, reduce inflammation and improve lipid disorders. Several brands are available, each having their own dosage guidelines. However, GLP-1 agonists may not be suitable for everyone. You must talk to your doctor to understand whether you should take GLP-1 agonists for your condition.
