Just about everyone has heard about the new weight loss drugs, a category of medicines approved by the Food and Drug Administration (FDA), some for diabetes and others specifically or weight loss. Now yet another benefit is coming to light that may help save lives: Doctors can use these medications to help patients avoid the onset of cardiovascular disease.
These medications, which include Ozempic®, Wegovy®, and Zepbound®, are part of a class of drugs known as GLP-1 medications because they mimic the action of a hormone called GLP-1 that controls blood sugar levels while decreasing appetite and slowing the digestive process. Read more about the details of these medications here.
In this Q&A, Icilma V. Fergus, MD, Director of Cardiovascular Disparities at The Mount Sinai Hospital, explains how these drugs can help patients lose weight and prevent the onset of cardiovascular disease, and lead to significant improvement in their lives—something she has been searching for ever since she became a cardiologist. The results of studies over the last five years, including one involving more than 8,000 patients, are driving this treatment.
Icilma V. Fergus, MD
“It has been rewarding to me to see the emotional transformation—as well as the physical transformation—as people start to shed weight when they had so much difficulty before” says Dr. Fergus, who is also Professor of Medicine at the Icahn School of Medicine at Mount Sinai. “The sense of winning a battle that they were never able to win before is life-changing for many. So as a cardiologist, I’m extremely grateful to have this tool in my toolkit.”
When did weight loss drugs come to your attention as way to increase heart health?
I focus on general and preventive cardiology, including the risk factors that can be addressed to minimize heart disease. At the top of the list would be hypertension, weight, diet, and exercise. Ever since I became a cardiologist, I’ve been looking for ways to get people to lose weight effectively. It has always been one of the toughest things to get somebody’s weight well controlled. Many of my patients have type 2 diabetes as well. These weight loss drugs have been approved to treat diabetes since 2005. We’ve seen how their weight loss not only treats their diabetes, but several of the risk factors for heart disease. Recently, there have been several studies that look at how GLP-1s address cardiovascular conditions.
What percentage of your patients could benefit from the use of weight loss drugs?
About 40 percent of my patients are overweight. A normal body mass index (BMI) is 25, and you are considered obese when you’re at 30. About 40 percent of my patients have a BMI greater than 25, and about 30 percent have a BMI greater than 30. That said, these drugs are not for everyone. They can cause side effects, such as nausea, diarrhea, or other gastrointestinal issues. Most of these side effects can be managed, and we always start off with a small dose to start and gradually increase it.
What has been your experience with these drugs?
I’ve seen a lot of dramatic success stories. It’s the beginning of a positive feedback loop. Patients start losing weight, so they’re able to exercise more. There’s less pain in their joints and less inflammation. They start feeling better about themselves, so the risk factors of stress and anxiety are relieved. They feel better about how they look, so they’re doing more, such as going out in public and going to the gym. And at the end of the day, their blood pressure is down. So perhaps they only need one drug instead of three. People are going from having diabetes to being in the pre-diabetes range. In many cases, it’s driving them to make other lifestyle changes, like eating healthier and eating less. But it’s important to note that results may vary. I do believe everyone is an individual, so there’s no cookie cutter method.
How do you get started?
A first step is to talk with your doctor. The guidelines from the clinical trials will tell you that the first step is making some basic changes to your lifestyle. It’s eating better, exercising, that type of stuff. Then after that comes the treatment. When you start treatment, I always emphasize the lifestyle behind it. But these drugs tend to force people to have good lifestyles.
How do these weight loss drugs affect my risk factors for heart disease?
By causing weight loss, these drugs alleviate a number of risk factors for heart disease. This includes:
- Reducing the risk of type 2 diabetes: Having fat—especially something called “visceral fat” that is stored deep in your abdomen around the organs—causes insulin resistance, or issues with processing glucose in your body. This can lead to type 2 diabetes, which is a major risk factor for heart disease.
- Reducing high blood pressure: In order to manage hypertension or high blood pressure, you need to be up and around and moving. If you have increased weight, it’s hard to do that. And with the visceral fat, you may not be absorbing your medications as well.
- Controlling your cholesterol levels: Obesity is a risk factor for lipid disorder. When you’re overweight, your good cholesterol, or HDL, goes down. Exercise and movement enable your HDL to go up. If you’re overweight, it’s harder to exercise for a number of reasons. Then there’s your bad cholesterol, or LDL, which goes up when you’re overweight.
- Reducing stress and anxiety: Many people become anxious, stressed, or depressed when they are overweight. Stress is a major contributor to heart disease. As you lose weight, your emotional state improves.
To sum up, I’m glad that these weight loss drugs are so much in the public eye. People hear about celebrities taking them and there’s automatically interest in the subject. But as a cardiologist, I can tell you that they have real benefits beyond losing weight—and one of them is heart health.