From Ozempic to Wegovy, GLP-1 medications have earned a somewhat negative reputation thanks to their overuse in Hollywood for rapid weight loss. But when prescribed under the supervision of a medical professional with a tailored plan for each patient, GLP-1s boast wellness benefits that go beyond fat reduction. For anyone with a history of heart attack, stroke or peripheral vascular disease, these medications can reduce risk of a future event by 20 percent.
Michelle Kelly, CRNP, a nurse practitioner at Trinity Health Mid-Atlantic Medical Group’s Cardiology Langhorne, breaks down why GLP-1s are beneficial for the cardiovascular system and how they’re a long-term commitment to wellness—not a quick fix.
What are GLP-1 medications?
The human gut already has GLP-1 receptors, which are hormones that help regulate blood sugar and our sense of hunger.
“GLP-1 receptor agonists, which are this class of medication, mimic and enhance that naturally occurring hormone to help us regulate blood sugar and promote satiety, which is appetite suppressant,” says Kelly.
Over the past 20 years, the uses of GLP-1 medications have greatly expanded. While they were once solely used to treat Type 2 diabetes after an initial FDA approval in 2005, their weight loss factor was eventually discovered, with an oral form of Wegovy approved in 2025 to treat obesity. Now, studies show that they are also beneficial from a cardiovascular perspective.
GLP-1s and the heart
In the cardiovascular space, these medications are being used more frequently as part of a treatment plan for anyone that has had a heart attack, stroke or peripheral vascular disease. According to recent studies, GLP-1s reduce a patient’s risk of experiencing a second event by 20 percent.
“We’re using it for risk reduction in the cardiovascular world, not so much for weight loss specifically,” says Kelly. “But there are bonuses. For patients with a BMI of over 27, which puts them overweight, they will still likely lose weight and have improvements in blood sugar, bad cholesterol, LDL levels and inflammatory markers.”
The reason why GLP-1s are beneficial for cardiovascular patients has to do with their anti-inflammatory effect on the vascular endothelium—a thin layer of cells lining the entire circulatory system that controls things like inflammation and coagulation. This anti-inflammatory effect reduces atherosclerosis—a chronic, progressive disease where plaque builds up inside artery walls, narrowing them and restricting blood flow. In turn, this lowers risk of heart attack and stroke in patients with a history.
A long-term commitment
There are a few misconceptions surrounding GLP-1s, especially regarding weight loss. Many believe them to be a magic fix—just take the medication for a few months, drop the pounds without doing anything extra and then abruptly stop. But for those who are on GLP-1s, especially cardiovascular patients, it’s a lifelong commitment that requires deep collaboration with a medical team and individualized care.
“By stopping the medication abruptly, it can bring back that inflammation rapidly, increasing risk for heart attack or stroke. This is a lifelong medication to protect them,” says Kelly. “I explain to my patients, ‘Yes, we’re going to get you to a healthy weight. But for you to continue to have that 20 percent reduction, you should stay on this medication. Can we lower it once you’re at a healthy weight? Yes.’ But I do recommend that patients with a past medical history of heart attack or stroke stay on it long-term.”
A collaborative effort
Last fall, Trinity Health Mid-Atlantic Medical Group launched a GLP-1 clinic, where cardiologists can refer patients with a history of heart attack or stroke to see if the medication may be a fit. Here, Kelly has in-depth conversations with each patient, explaining the risks and rewards of GLP-1s, the hormonal and hereditary influences of obesity, and the importance of incorporating nutrition and exercise into their daily lifestyle. Due to the weight loss component of GLP-1s, protein-rich foods and weight training are vital to avoid losing significant muscle mass.
Every eight weeks, patients are asked to return to the clinic so that Kelly can see how they’re doing. If they’re having severely negative side effects, such as nausea that’s prohibiting them from eating, or losing more than two to three pounds per week, the dosage will be adjusted.
“GLP-1s should not be prescribed and then you follow up with them in a year. These patients need to be monitored closely. We check their blood sugars, blood pressure. The goal isn’t to jump them up to the highest dose as fast as possible,” says Kelly. “I always say this is a marathon, not a sprint. This is something that’s long-term.”
Who shouldn’t start a GLP-1
Sometimes, the risks outweigh the benefits for cardiovascular patients who are considering starting a GLP-1 medication. According to Kelly, the following should take caution:
- Those with a personal or family history of thyroid cancer
- Elderly patients due to increased risk of fractures (a DEXA scan is completed first to determine their bone density)
- Those who have lost weight (medically or not) and still have their gallbladder, with three gallbladder attacks in the past year
- Diabetics with a history of retinopathy (Kelly will first reach out to their ophthalmologist)
Final words
These medications may have become synonymous with Hollywood in recent years, but there are tangible benefits and risk reduction for cardiovascular patients. It’s important to remember that they’re not a magic fix-all, nor something to be taken lightly—GLP-1s require a personalized, fluid action plan and a commitment to healthy lifestyle changes.
“GLP-1 receptors do have a great impact on cardiovascular health. They do reduce the risks of major adverse cardiovascular events in patients with already established heart disease. So it’s something to consider,” says Kelly. “These medications are safe if they’re monitored appropriately and patients are willing to commit to diet, exercise and nutrition along the way.”