GLP-1 Drugs Can Be Used First for Weight Loss, Says American College of Cardiology

With this article it is hard not to believe that the medical industry has no intention of working on getting you healthier, but more on creating more drugs…..l

The American College of Cardiology (ACC) gave popular obesity medications equal standing with diet and exercise as a first-line strategy for weight management.

In new concise clinical guidance, the ACC promoted current-generation nutrient-stimulated hormone (NuSH) therapies — namely the GLP-1 receptor agonists semaglutide (Ozempic, Wegovy) and tirzepatide (Zepbound, Mounjaro) — as upfront pharmacological weight management for the optimization of cardiovascular health.

“Patients should not be required to ‘try and fail’ lifestyle changes prior to initiating pharmacotherapy; nonetheless, lifestyle interventions should always be offered in conjunction with NuSH therapies,” wrote Olivia Gilbert, MD, MSc, of Atrium Health Wake Forest Baptist Medical Center in Winston-Salem, North Carolina, and colleagues.

The recommendations were published in the Journal of the American College of Cardiology.

“Weight management by the cardiovascular community needs to be embraced, given both the prevalence of obesity and the impact it has on many forms of CVD [cardiovascular disease],” Gilbert said in a press release.

Her group cited evidence that average weight loss can approach 10% with lifestyle modification (e.g., diet and exercise), whereas it more typically reaches 15% with semaglutide and 20% with tirzepatide.

“Disappointingly, weight loss achieved with lifestyle interventions has not been associated with a reduction in adverse cardiovascular outcomes. Although bariatric surgery is able to achieve substantial weight loss and reduced CVD events, it may be less desirable for some patients,” the ACC committee wrote.

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More effective than lifestyle interventions and with less risk than procedure-based interventions, modern obesity medications are increasingly relevant to cardiologists for CVD modification. The intent of the current document is to provide the foundation for cardiologists to medically manage obesity using agents with proven CVD benefit,” they added.

Indeed, GLP-1 drugs have been shown not only to help people shed weight and manage glucose, but also to help reduce one’s cardiovascular risk. Last year, semaglutide was FDA approved for cardiovascular protection, alongside lifestyle intervention in people with cardiovascular disease and either obesity or overweight, based on the large SELECT trial.

For its part, the dual GLP-1/GIP receptor agonist tirzepatide reduced heart failure risk in people with heart failure with preserved ejection fraction in last year’s SUMMIT trial. However, developer Eli Lilly recently withdrew its application for this FDA indication for tirzepatide, reportedly due to the regulators’ request for more studies.

The ACC noted in its new recommendations that candidates for GLP-1 drugs should have eligibility determined by body mass index (BMI) or other risk indicators.

Gilbert and colleagues also acknowledged a need to improve access to these therapies, citing challenges with insurance coverage and price negotiations.

With semaglutide and tirzepatide dosed once weekly, their estimated average yearly costs in the U.S. are $14,080 and $8,126, respectively. What’s more, obesity alone as an indication bars coverage under Medicare Part D.

Gastrointestinal adverse effects appear to be chief among the side effects of GLP-1 medications. Additionally, there are concerns emerging about eye-related complications like nonarteritic anterior ischemic optic neuropathy and neovascular age-related macular degeneration.

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