Cardiologists: GLP-1 Drugs Should Be a First-Line Weight Loss Treatment

In a statement that could affect millions of Americans, the American College of Cardiology released new clinical guidance encouraging physicians to “embrace” the use of GLP-1 receptor agonists — popularly known as weight-loss drugs such as Wegovy and Ozempic — for patients with obesity and heart disease.

Patients should not be required to “try and fail” at losing weight on their own before these medicines are considered, the experts contend. While lifestyle changes remain the foundation of obesity management, the new guidance recommends considering these medications as a first-line treatment option alongside diet and exercise for eligible patients.

Region’s Only Cardiometabolic Clinic

The approach is not new to the experts at Baptist Health Miami Cardiac & Vascular Institute, which several years ago established South Florida’s first — and so far only — Cardiometabolic Clinic. The program takes a multidisciplinary approach to addressing a wide range of cardiovascular risk factors, particularly among patients with diabetes and other metabolic conditions.

“The medications can really help people get healthier and stay healthier,” says preventive cardiologist Jonathan Fialkow, M.D., the Institute’s chief of cardiology and Baptist Health’s chief medical executive of Integrated Services and Precision Care. “Let’s use what weapons are established and medically sound, safe and available. And certainly, if we can help a patient improve their lifestyle over time and get off the medications — great.”

Weight Loss Drugs Boost Heart Health

New research shows that GLP-1 receptor agonists do more than help people shed pounds; they also improve heart health, lowering the risk of heart failure and serious cardiac events like heart attacks and strokes.

“Interestingly, it’s not purely because of weight loss. They have mechanisms that improve metabolism and decrease inflammation,” Dr. Fialkow says. “Getting to the root of improving metabolism involves various hormonal changes in the gut, hormonal changes in the brain. And these medications seem to help with that.”

GLP-1 (glucagon-like peptide-1) receptor agonists were originally developed to treat type 2 diabetes. They work by mimicking a hormone that helps regulate blood sugar, slow digestion and reduce appetite. Drugs like semaglutide (brand names Wegovy and Ozempic) and tirzepatide (brand name Zepbound and Mounjaro) have shown remarkable effectiveness in helping people lose weight — often 15 percent or more of their body weight.

Dr. Fialkow says doctors have known for some time that patients with diabetes who use these medications have a reduced risk of heart attack, stroke and death from cardiovascular causes. Now, that’s expanding to patients who are obese or those with heart failure. The recommendations are part of an expert consensus published in the Journal of the American College of Cardiology regarding medical weight management for cardiovascular health.

Experts Term Obesity a ‘Chronic Disease’

The statement emphasizes that obesity should be viewed and treated as a chronic disease, not a personal failing. It urges doctors to stop hesitating when it comes to prescribing weight-loss medications that can help get patients on the right track, especially for those who are also at high risk for heart disease. Clinical evidence supports the use of these medications to reduce major adverse cardiovascular events, particularly in individuals with type 2 diabetes and elevated cardiovascular risk.

GLP-1 drugs are not for everyone; they can have side effects like nausea and vomiting, and they can cause the loss of muscle tone and strength for people who don’t exercise and stay active. Patients must be carefully monitored, which is why the multidisciplinary approach of the Institute’s Cardiometabolic Clinic can be so helpful, Dr. Fialkow says.

A Comprehensive Approach to Heart Health

Comprehensive treatment includes blood pressure management, lipid-lowering therapies and glucose-lowering medications. The program also involves nutrition guidance, education and social work components.

“We don’t just say take this medication; we look at sleep, we look at exercise, we look at diet, we look at stress. We want to get our patients on the proper preventive medications and on the road to improved health,” Dr. Fialkow explains.

The concept of a dedicated multidisciplinary clinic to treat cardiometabolic disorders is novel but growing. A leader in the preventive cardiology field, Miami Cardiac & Vascular Institute is a charter member of the Cardiometabolic Center Alliance, a national collaborative of healthcare organizations committed to helping patients better manage their conditions.

“If you think about a patient who has diabetes, hypertension, fatty liver disease or kidney disease, that patient may seek care from three or four specialists who usually work in silos in their own areas,” says Sergiu Darabant, M.D., a medical cardiologist Miami Cardiac & Vascular Institute. “What you need is someone to look at the whole picture.”

Jonathan Fialkow, M.D., chief of cardiology at Baptist Health Miami Cardiac & Vascular Institute and Baptist Health’s chief medical executive of Integrated Services and Precision Care

Sergiu Darabant, M.D., a medical cardiologist at Baptist Health Miami Cardiac & Vascular Institute