Our cardiologists prescribe GLP-1 medications, including semaglutide (Wegovy, Ozempic) and tirzepatide (Zepbound, Mounjaro), in a weight management program built to lower the risk of atherosclerosis and heart failure. Excess weight raises cardiovascular risk on two sides: in the arteries it comes with higher blood pressure, ApoB, triglycerides, and blood sugar, and in the heart muscle it adds load that stiffens the ventricle and enlarges the left atrium over years. Treatment is managed in the same plan as ApoB and Lp(a) treatment, blood pressure, coronary imaging, and follow-up of heart structure and function.
On the artery side, excess weight often shows up alongside several other risk factors at the same time: blood pressure that's a little higher than it was a few years ago, higher ApoB and triglycerides, and a hemoglobin A1c approaching the diabetes range. A family history of early heart disease or a coronary calcium score above zero makes each of them more important to treat.
102 measurements · 14 constructs
Weight fell 14 kg (13%) over 50 weeks on semaglutide titrated to 2.4 mg weekly. On echocardiography, the E/e' ratio, an estimate of left ventricular filling pressure, fell. Left atrial volume index, a measure of left atrial size, rose from 33 to 36 mL/m² in the year before treatment and was 35 mL/m² on the latest echocardiogram. Without treatment it would be expected to keep rising, as it did in the placebo group of the STEP-HFpEF trial. Holding steady is therefore a favorable result, since continued left atrial enlargement is associated with atrial fibrillation and heart failure. Systolic blood pressure fell enough to reduce amlodipine from 10 mg to 5 mg, and triglycerides and HbA1c improved. ApoB fell modestly and remains above goal on rosuvastatin, so additional lipid-lowering therapy is under consideration. Lp(a) was unchanged, as expected for a genetically determined value.
Example view. Synthetic patient and synthetic values — not a real person, and not medical advice.
Weight also adds load to the heart muscle, and over years that load stiffens the ventricle and enlarges the left atrium, which is the path toward atrial fibrillation and heart failure with preserved ejection fraction. That side of the heart is measured with an echocardiogram, which the other half of your heart describes in detail.
Weight loss lowers blood pressure, triglycerides, and blood sugar and takes load off the heart muscle, so managing weight as part of cardiovascular prevention puts both sides in the same plan as ApoB, Lp(a), blood pressure, and coronary imaging.
In STEP 1, 1,961 adults without diabetes and with a body-mass index of 30 or higher (27 or higher with a weight-related condition) took weekly semaglutide 2.4 mg or placebo alongside lifestyle intervention. At 68 weeks, body weight had fallen 14.9% on semaglutide and 2.4% on placebo (difference 12.4 percentage points, 95% CI 11.5 to 13.4), with greater improvement in cardiometabolic risk factors on semaglutide.
SURMOUNT-1 tested tirzepatide in 2,539 adults without diabetes under the same body-mass index criteria. At 72 weeks, weight had fallen 15.0%, 19.5%, and 20.9% on the 5, 10, and 15 mg doses, against 3.1% on placebo, and every prespecified cardiometabolic measure improved with tirzepatide.
The clearest outcome evidence comes from the SELECT trial. It enrolled 17,604 people aged 45 or older with established cardiovascular disease and a body-mass index of 27 or higher, none of whom had diabetes, and randomized them to weekly semaglutide 2.4 mg or placebo. Over a mean follow-up of 39.8 months, cardiovascular death, heart attack, or stroke occurred in 6.5% of the semaglutide group and 8.0% of the placebo group (hazard ratio 0.80, 95% CI 0.72 to 0.90).
That's about one major cardiac event prevented for every 67 people treated for a little over three years. Because none of the participants had diabetes, the result applies directly to people who don't have it.
SELECT enrolled only people who already had cardiovascular disease. SURMOUNT-MMO, an outcome trial of tirzepatide that also enrolls people with cardiovascular risk factors but no established cardiovascular disease, is expected to finish in late 2027. Until those results are available, treatment in people without established disease is based on the improvements in blood pressure, triglycerides, and blood sugar that weight loss produces.
Obesity is a risk factor for atrial fibrillation and increases the risk of heart failure with preserved ejection fraction. Trials in people who already have these conditions show that both respond to treatment aimed at weight. In a 2013 randomized trial in overweight and obese patients with atrial fibrillation, structured weight loss (14.3 kg against 3.6 kg) reduced AF symptom burden and the frequency and total duration of episodes. In the SUMMIT trial of heart failure with preserved ejection fraction and obesity, tirzepatide lowered cardiovascular death or worsening heart failure from 15.3% to 9.9% over a median of two years (hazard ratio 0.62, 95% CI 0.41 to 0.95), driven by fewer worsening heart failure events.
In the echocardiography substudy of STEP-HFpEF, which measured the heart muscle's response directly, 491 participants with obesity-related heart failure with preserved ejection fraction had an echocardiogram at randomization and after 52 weeks. Left atrial volume rose by 6.89 mL on semaglutide and by 13.02 mL on placebo (difference −6.13 mL, 95% CI −9.85 to −2.41). The average E/e′ ratio, an estimate of filling pressure, fell by 0.79 relative to placebo, a borderline difference (95% CI −1.60 to 0.01), and ejection fraction and global longitudinal strain didn't change. The participants already had heart failure, so the result shows that atrial enlargement in obesity-related heart disease can be slowed, in a population further along than a prevention patient. The example record above follows left atrial size and the E/e′ ratio as its heart-muscle readouts, next to weight, blood pressure, and the lipid panel.
Weight reduction changes the rest of a prevention plan, and those changes are made at the same visits:
Doses start low and increase in steps over several months, mainly to keep nausea, vomiting, diarrhea, and constipation manageable. In STEP 1, nausea and diarrhea were the most common side effects of semaglutide, typically transient and mild to moderate, and 4.5% stopped because of gastrointestinal effects against 0.8% on placebo. In SURMOUNT-1, gastrointestinal effects were the most common with tirzepatide, mostly mild to moderate and concentrated in the dose-escalation period, and between 4.3% and 7.1% stopped because of adverse events, depending on dose, against 2.6% on placebo. Follow-up during escalation reviews side effects alongside weight, blood pressure, and the rest of the medication list.
Yes, GLP-1-based medications such as semaglutide and tirzepatide can be prescribed by any physician licensed to prescribe. Our cardiologists prescribe them as part of cardiovascular prevention and manage them alongside lipid and blood pressure treatment, so changes elsewhere in the regimen happen at the same visits.
The strongest evidence is from the SELECT trial, in people who already had cardiovascular disease, where semaglutide lowered the rate of cardiovascular death, heart attack, or stroke from 8.0% to 6.5% over a mean of about 3.3 years. SURMOUNT-MMO, an outcome trial of tirzepatide that also enrolls people who don't have established cardiovascular disease, is expected to finish in late 2027. Until those results are available, treatment for people who don't have established disease is based on the improvements in blood pressure, triglycerides, and blood sugar that weight loss produces.
Weight loss lowers some lipid values more than others. Triglycerides usually fall substantially, LDL cholesterol falls modestly, and Lp(a) doesn't change because it's genetically determined. Many people still need a statin, ezetimibe, or a PCSK9 inhibitor to bring ApoB and LDL to target, and that's managed in the same plan as the weight treatment.
Wegovy is semaglutide at a weekly dose of 2.4 mg. Its cardiovascular outcome evidence comes from the SELECT trial, which enrolled 17,604 people aged 45 or older with established cardiovascular disease and a body-mass index of 27 or higher, none of whom had diabetes. In that trial it lowered the rate of cardiovascular death, heart attack, or stroke from 8.0% to 6.5%. In people without established cardiovascular disease, it's prescribed for its effects on weight, blood pressure, triglycerides, and blood sugar.
Evidence-based cardiovascular risk reduction — moving beyond standard guidelines using genomics, advanced biomarkers, and modern imaging.
Beyond standard cholesterol — apoB, Lp(a), advanced testing, and modern lipid-lowering therapy including PCSK9 inhibitors.
When LDL or apoB is elevated — what the numbers mean, what testing helps, and how treatment is decided.
What a cardiologist adds for patients on or considering a GLP-1 (semaglutide, tirzepatide, liraglutide) when weight loss is part of the picture.
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