Bengaluru: For years, obesity and other weight-related conditions have complicated the management of cardiovascular disease. Now, as clinical trials show that glucagon-like peptide-1 (GLP-1) drugs can deliver significant weight loss even in people without diabetes, cardiac specialists in the city say the medicines could bring a shift in cardiovascular care.Dr Arunkumar Ullegaddi, consultant, adult cardiology, Narayana Institute of Cardiac Sciences, said GLP-1 drugs were initially developed as antidiabetic medicines, but their weight-loss benefits became increasingly evident over time. “GLP-1 drugs were initially researched and identified as antidiabetic medicines. Over time, researchers found that they also had a significant effect on weight reduction. For years, patients with obesity would commonly ask doctors whether there was a medicine that could help them lose weight, and we had to tell them there wasn’t an effective option. Today, when patients ask the same question, we can tell them medicines are available.”He added that patients are initially apprehensive because the drugs are injectable and may have side effects. However, their growing use and the body of clinical evidence have increased acceptance.“These drugs have been extensively studied, with findings published in national and international journals. They are also being used by film stars and political leaders, which has increased their acceptance. Many people who struggled to lose weight for years have seen significant results with these medicines,” he said.Doctors said people with a body mass index (BMI) above 27.5, particularly those with obesity-related complications, and those with a BMI of 30 or above may be considered for GLP-1 drugs, depending on their overall health profile.“GLP-1 drugs may be considered for people who are overweight or obese, particularly those with conditions such as heart failure with preserved ejection fraction, chronic kidney disease, diabetes or multiple cardiovascular risk factors. The benefit is especially clear in those with established cardiovascular disease,” said Dr Sanjay S Bhat, lead senior consultant – interventional cardiology, department of cardiology, Ramaiah Memorial Hospital.He said semaglutide 2.4mg is approved to reduce the risk of cardiovascular death, heart attack and stroke in people with established cardiovascular disease who are overweight or obese, even without diabetes. However, he noted that GLP-1 drugs are not routinely recommended solely to prevent cardiovascular events in people without established heart disease or significant risk factors.Dr Keshava R, HOD & consultant – interventional cardiology, Manipal Hospitals, Old Airport Road, said GLP-1 drugs can have cardiovascular benefits beyond weight loss and blood sugar control. “They have beneficial effects on blood pressure, blood sugar and cholesterol, while reducing major cardiovascular events in patients with ischaemic heart disease. They may also lower cardiovascular risk in patients with multiple blockages, including those who have undergone angioplasty or bypass surgery. These drugs reduce epicardial and visceral fat,” he said.Lifestyle measuresDoctors, however, stressed that the medicines should complement, not replace, lifestyle measures. A healthy diet, calorie control, regular exercise, adequate sleep, smoking cessation and control of blood pressure and cholesterol remain essential.Dr Keshava also cautioned against unsupervised use, saying it could lead to excessive weight and muscle loss, weakness, and side effects such as nausea, vomiting and diarrhoea. As the drugs suppress appetite, inadequate nutrition may also result in vitamin deficiencies and other complications.“Dosages should be increased gradually under medical guidance, alongside attention to diet, exercise and maintaining muscle mass. For those at high risk of heart disease, lifestyle changes and control of blood pressure, blood sugar and cholesterol remain the cornerstone of treatment,” he said.
