About half of overweight adults who fall just below the weight cutoff for GLP-1 drugs had blood markers that put their risk of coronary heart disease on par with people who already qualify, according to Danish research being presented at the European Association for the Study of Diabetes meeting in Milan (Sept 28 to Oct 2).
If your BMI is between 25 and 26.9, about half of people in your weight range had high remnant cholesterol, inflammation, or both, and that raised their heart risk. It is not a reason to go looking for a GLP-1 prescription. Nobody has tested whether these drugs prevent heart disease in this group.
Whether a drug pays off for healthy people whose heart risk sits in the middle is a question one large cholesterol-pill trial already put to the test.
Key takeaways
- Among people with a BMI of 25 to 26.9, 44% to 48% had high remnant cholesterol, low-grade inflammation, or both.
- Those people were just as likely to develop coronary heart disease as people who qualify for semaglutide or tirzepatide for weight loss.
- The study measured risk only. It did not test whether GLP-1 drugs lower that risk, and the lead researcher says trials are needed.
What the study found
Semaglutide and tirzepatide are approved for weight loss in adults with a BMI of 30 or more, or 27 or more plus at least one weight-related condition, such as high blood pressure or unhealthy cholesterol. People with a BMI of 25 to 26.9 are overweight but do not qualify.
Dr. Karen Hvid of Copenhagen University Hospital, Herlev, and colleagues pooled data from two large studies, the UK Biobank and the Copenhagen General Population Study. Together they covered 313,145 overweight adults (median age 58, about half women) who had no coronary heart disease and no diabetes at the start.
Over more than ten years of follow-up (up to 18 years in the Danish study and up to 15 in the UK study), 23,134 people developed coronary heart disease. That included a diagnosis, a heart attack, bypass surgery, a procedure to open a blocked artery, or death from heart disease.
About two-thirds of participants (204,850) would qualify for GLP-1 drugs under current rules. More than 90% of those who would not qualify had a BMI of 25 to 26.9.
The researchers looked at two markers: remnant cholesterol, which is cholesterol that is not HDL or LDL, and chronic low-grade inflammation. Both raise heart risk and both are common in people who are overweight.
People who did not qualify for the drugs but had high levels of both markers had about a 41% higher risk (Danish study) and a 47% higher risk (UK study) than people who did not qualify and had healthy levels. People who did qualify had about a 41% higher risk in the Danish study and 35% in the UK study.
Dr. Kumar’s take
The press release is titled “Millions more people with overweight could benefit from GLP-1 drugs.” The study does not show that. It shows that a group of people carries a similar risk. Whether a drug lowers that risk is a separate question, and it was not asked here. Dr. Hvid says so herself: “Clinical trials are now needed.”
This is an observational study. It can show who gets heart disease more often. It cannot show that treating the markers, with any drug, changes the outcome.
Declared ties are worth knowing. The lead author reports consulting for MSD, a co-author lists consulting or talks for Novo Nordisk, Lilly and others, and two of the funders are funded by the Novo Nordisk Foundation.
The useful part is the blood markers. They sort people who look alike on the scale into two groups with different risk. That is something a reader can use today.
I am working from the conference press release here; the full paper was not available to me.
What it means for you
In this study, about half of people with a BMI of 25 to 26.9 had high remnant cholesterol, inflammation, or both, and those markers raised their heart risk.
A high result tells you your heart risk may be closer to that of heavier people than your weight suggests. It is a reason to take food, activity and weight seriously now. Ultra-processed foods were linked to a 47% higher heart disease risk in one analysis, so what is on your plate is a fair place to start.
Whether any medicine makes sense for you is a decision for you and your doctor, based on your full picture.
Source: European Association for the Study of Diabetes press release via EurekAlert