GLP-1 Drugs May Cut Heart Risk in Overweight BMI 25-26.9
New research finds nearly half of people with a BMI of 25-26.9 have high remnant cholesterol and inflammation, elevating heart disease risk.
A new study suggests GLP-1 drugs could reduce heart disease risk for overweight people with a BMI of 25-26.9 who are not currently eligible for treatment. Research indicates nearly half of individuals in this BMI range have elevated remnant cholesterol and low-grade inflammation, placing them at higher cardiovascular risk.
The analysis included 313,145 individuals with a BMI of 25 or higher, all free of coronary heart disease and diabetes at the start. The median age was 58, and about half were female. While roughly two-thirds of the cohort were eligible for GLP-1 receptor agonists under current guidelines, more than 90% of those not eligible had a BMI between 25 and 26.9. Within this specific overweight group, approximately half showed high remnant cholesterol, low-grade inflammation, or both.
Those without a current drug indication but with these elevated risk markers faced a significantly higher chance of developing cardiovascular disease. Their risk was 41% higher in one cohort and 47% higher in another compared to ineligible individuals with healthy biomarker levels. Dr. Karen Hvid of Copenhagen University Hospital in Herlev, Denmark, who led the study, noted the potential of these medications. "We know that GLP-1 RAs can cut cholesterol and inflammation and reduce the risk of heart attacks, strokes and other cardiovascular problems," Hvid said.
GLP-1 drugs show heart benefits beyond weight loss
Evidence is mounting that drugs like semaglutide offer cardiovascular protection through mechanisms not fully explained by weight loss alone. Semaglutide, sold under brand names like Wegovy and Ozempic by Novo Nordisk, is approved for weight loss in adults with a BMI of 30 or higher, or a BMI of 27 or higher with a weight-related condition.
The landmark SELECT trial studied semaglutide in adults without diabetes to assess its cardiovascular effects. A subsequent analysis led by Professor Helen Colhoun of the University of Edinburgh found that improvements in weight, waist circumference, blood pressure, and lipids accounted for no more than half of the observed reduction in heart disease risk. The study concludes that semaglutide should be considered a cardiovascular disease reduction drug, not solely a weight-loss treatment. The precise biological mechanisms behind these benefits remain an area for further research.
Researchers call for expanded drug access and trials
The data makes a case for broadening access to GLP-1 receptor agonists. Individuals with a BMI of 25-26.9 are classified as overweight but do not qualify for these drugs under existing indications. The study suggests extending eligibility to about half of the people in this BMI bracket-those with elevated remnant cholesterol and inflammation-could help reduce population-level heart disease risk.
This proposed expansion targets a group whose relative risk increase is comparable to those already eligible for treatment. Hvid argues the findings support a change in approach. "Our study makes the case for extending the indication to this group. Clinical trials are now needed," she stated. Confirming these observational findings in dedicated clinical trials is the necessary next step.
