What the trials revealed
The GLP-1 receptor agonists weren't designed as cardiac drugs. Semaglutide and liraglutide came out of the diabetes and obesity pipelines. Empagliflozin, dapagliflozin, and the rest of the SGLT2 inhibitors started the same way. Both drug classes have turned out to be among the most consequential new cardiac drug classes of the last decade, with cardiovascular outcome trials showing reductions in cardiovascular events, heart-failure hospitalizations, kidney disease progression, and all-cause mortality.
The effect sizes are larger than what cardiology trials typically produce. That pattern is informative on its own. Drugs that lower weight and glucose can reduce cardiac outcomes this much only if there was a meaningful amount of cardiac disease tied to the weight to begin with. For many patients, that disease wasn't being actively recognized or managed.
Conditions we look for
A handful of cardiovascular conditions are frequently missed in patients whose care has been focused on weight. We screen for these when the history warrants:
- HFpEF (heart failure with preserved ejection fraction). Exertional shortness of breath often gets attributed to deconditioning. Echocardiogram plus NT-proBNP identifies HFpEF in patients who would otherwise be missed.
- Atrial fibrillation. Palpitations often get attributed to anxiety. Paroxysmal AF won't show up on a routine in-office EKG. A wearable rhythm patch or a short ambulatory monitor is the right tool when the history is suggestive.
- Elevated apoB and Lp(a). Standard lipid panels report LDL, HDL, and triglycerides. ApoB and Lp(a) need to be ordered specifically. Both are now part of the 2026 ACC/AHA dyslipidemia recommendations.
- Soft (non-calcified) coronary plaque. A coronary calcium score of zero is reassuring but doesn't rule out soft plaque, which is the kind more prone to rupture. CCTA with AI quantification is the test that detects it. More in our piece on when CCTA actually changes care.
- Chronic kidney disease with albuminuria. eGFR alone misses early kidney damage. The urine albumin-to-creatinine ratio is the screening test and isn't typically part of routine bloodwork. Both SGLT2 inhibitors and semaglutide are now guideline-supported therapies for it.
What we don't do
- We don't prescribe GLP-1s. Your existing prescriber keeps the prescription. This isn't a weight-loss clinic, and we don't compete with primary care or endocrinology for prescribing authority.
- We don't replace your existing care chain. Primary care, endocrinology, your weight-loss program, and any other providers stay where they are. The cardiology visit adds a layer that often isn't otherwise present.
- We don't screen everyone on a GLP-1. Testing decisions are driven by risk profile and history. Patients without cardiovascular risk factors usually don't need extensive workup.
Who benefits most from this visit
- Patients in their 40s or older who are on or starting a GLP-1 and have a family history of cardiovascular disease.
- Patients with elevated LDL, unknown apoB or Lp(a), or a history of borderline blood pressure or lipid abnormalities.
- Patients with exertional shortness of breath that's been attributed to weight or deconditioning but hasn't been formally evaluated.
- Patients with palpitations, prior brief episodes of irregular heart rhythm, or family history of atrial fibrillation.
- Patients with kidney function changes, even mild, who haven't had albuminuria screening.
- Patients losing meaningful weight on a GLP-1 who want a clean read on residual cardiovascular risk.
What a virtual visit looks like
- First visit by video. Detailed history including the GLP-1 prescription context, weight trajectory, and any cardiovascular symptoms. Review of prior labs and imaging if available.
- Targeted workup. Lab orders sent to a local Quest or LabCorp; imaging coordinated with a local provider when indicated.
- Written plan. Specific next steps, including lipid optimization, any HFpEF or AFib evaluation, and what to track over time.
- Follow-up every 3 to 6 months once a stable plan is in place, more frequently during active medication titration.
How this connects to other care
Most patients on a GLP-1 have a fragmented care picture: a prescriber for the GLP-1, a primary care physician who may or may not be in that loop, no cardiologist, and lab work that hasn't been interpreted with the cardiovascular dimension in mind. The cardiology visit doesn't try to replace any of those. It adds the integrating layer. We send our notes back to the primary care physician and any other named providers, with explicit recommendations on what to monitor and when to escalate.