Millions more people with overweight could benefit from GLP-1 drugs to protect heart health, study suggests

by European Association for the Study of Diabetes

edited by Gaby Clark, reviewed by Robert Egan

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New research being presented at the annual meeting of the European Association for the Study of Diabetes (EASD) in Milan, Italy, Sept. 28–Oct. 2, makes a case for extending the indication for GLP-1 receptor agonists (GLP1-RAs) to millions more people to protect their heart health.

The GLP-1 RA drugs semaglutide and tirzepatide are approved for weight loss in adults with a BMI of ≥30 or a BMI of ≥27 plus at least one weight-related health condition, such as dyslipidemia (unhealthy levels of cholesterol or other fats in the blood), high blood pressure, type 2 diabetes or previous cardiovascular disease.

Individuals with a BMI of 25–26.9 are not eligible, despite being in the overweight range. The Danish analysis of data on hundreds of thousands of people in the U.K. and Denmark provides evidence for extending the indication to include about half of those in this group to cut their risk of heart disease.

In this study, the first of its kind, Dr. Karen Hvid of Copenhagen University Hospital in Herlev, Denmark, and colleagues compared the risk of coronary heart disease in individuals with a BMI of 25–26.9 and high remnant cholesterol and/or low-grade inflammation with the risk in individuals who were eligible for GLP-1 RAs for weight loss. Chronic low-grade inflammation and remnant cholesterol (the term used to describe cholesterol that isn't HDL or LDL) both increase the risk of heart disease and are common in people who are overweight.

Two large prospective studies, the UK Biobank and the Copenhagen General Population Study (CGPS), provided data on 313,145 individuals with a BMI of 25 or higher (median age 58, approximately 50% female) who were free of coronary heart disease and diabetes.

During follow-up of more than 10 years (up to 18 years in the CGPS and up to 15 years in the UK Biobank), 23,134 developed coronary heart disease, defined as receiving a diagnosis, having a heart attack, undergoing coronary artery bypass or percutaneous coronary artery intervention (a procedure to open a narrowed or blocked artery), or dying of cardiovascular causes.

About two-thirds of the participants (204,850) were eligible for GLP-1 RAs under the current indication.

More than 90% of those not eligible had a BMI of 25–26.9, and approximately half of those with a BMI of 25–26.9 (44% in the CGPS and 48% in the UK Biobank) had either high remnant cholesterol, low-grade inflammation or both.

Analysis of the data showed that participants who weren't covered by the indication but had high remnant cholesterol, low-grade inflammation or both were just as likely to develop coronary heart disease as those who were eligible for the drugs.

For example, individuals without a GLP-1 RA indication but with elevated remnant cholesterol and low-grade inflammation were 41% more likely in the CGPS and 47% more likely in the UK Biobank to develop cardiovascular disease than those without an indication and with healthy levels of cholesterol and inflammation.

This compares with an increased risk of heart disease of 41% among those in the CGPS with an indication and 35% among those in the UK Biobank with an indication.

Hvid says, "We know that GLP-1 RAs can cut cholesterol and inflammation and reduce the risk of heart attacks, strokes and other cardiovascular problems.

"We found that about half of people with a BMI of 25–26.9 had levels of cholesterol and/or inflammation that increased their risk of heart problems.

"They had a similar risk of coronary heart disease as those who were eligible for GLP-1 RAs for weight loss—but, as things stand, they would not be prescribed them.

"Our study makes the case for extending the indication to this group. Clinical trials are now needed."

Key medical concepts

Glucagon-Like Peptide-1 Receptor AgonistsCoronary DiseaseOverweight

Clinical categories

CardiologyWeight managementEndocrinologyClinical pharmacologyCommon illnesses & PreventionHealthy living Provided by European Association for the Study of Diabetes Who's behind this story?

Gaby Clark

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Citation: Millions more people with overweight could benefit from GLP-1 drugs to protect heart health, study suggests (2026, September 27) retrieved 27 September 2026 from https://medicalxpress.com/news/2026-09-millions-people-overweight-benefit-glp.html This document is subject to copyright. Apart from any fair dealing for the purpose of private study or research, no part may be reproduced without the written permission. The content is provided for information purposes only.