Moving Beyond Blood Sugar – The Role of GLP-1s (Ozempic, Wegovy) in Cardiovascular Disease Prevention

Summary

GLP-1 drugs like Ozempic and Wegovy are no longer just diabetes and weight-loss agents—they’re emerging as powerful tools for cardiovascular disease prevention. Backed by trials like SUSTAIN 6 and SELECT, GLP-1s have shown reduced risk of heart attack, stroke, and cardiovascular death, especially in patients with type 2 diabetes or obesity. However, clinical use should still be targeted: SGLT-2s like Jardiance and Farxiga remain superior in heart failure, while GLP-1s lead in stroke prevention. As prescribing expands, payers and providers must balance evidence with prudence to ensure smart, high-impact use.

Injectables like Ozempic, Wegovy, and Mounjaro have become household names in diabetes and weight management—but they’re moonlighting in another high-stakes role: cardiovascular disease prevention. While the strongest data still ties their benefit to people with type 2 diabetes, there’s growing momentum to consider GLP-1s in broader cardiovascular contexts. The key? Knowing when to lean in—and when to pivot elsewhere.¹

Early Evidence: Cardioprotection in Diabetes

The idea of GLP-1s as heart helpers isn’t exactly new. Trials like SUSTAIN 6 (semaglutide/Ozempic) launched early in the drug’s lifecycle, showing a reduction in cardiovascular death, non-fatal myocardial infarction, and non-fatal stroke among high-risk patients with type 2 diabetes.² These findings weren’t a one-off—REWIND and other large-scale trials have echoed the message: GLP-1s can reduce major cardiovascular events in patients already battling diabetes.³

So Why Isn’t Everyone on a GLP-1?

Despite the promise, GLP-1s aren’t handed out like multivitamins. Historically, they’ve been reserved for people with diabetes and/or obesity—two conditions that compound cardiovascular risk. But that’s beginning to shift. Increasingly, prescribers are looking at GLP-1s through a broader lens: not just who has diabetes, but who’s at risk.⁴

Breaking New Ground: Cardiovascular Use Without Diabetes

Cue the SELECT trial—a seismic shift in the landscape. Semaglutide was shown to reduce cardiovascular events in overweight or obese patients without diabetes but with existing cardiovascular disease. That’s a big deal. It suggests GLP-1s may have a place in patients who don’t meet the traditional diabetes threshold. But pump the brakes—evidence is still limited in patients without existing cardiovascular disease.⁵

Prescribing Clarity: GLP-1 or SGLT2?

According to the American Heart Association, patients with type 2 diabetes who have failed first-line therapies and possess additional cardiovascular risk factors may be candidates for either GLP-1s or SGLT-2 inhibitors.⁶ But like most tools, these agents have specialties:

• SGLT-2 inhibitors shine in reducing hospitalization and death in heart failure.

• GLP-1s excel at cutting stroke risk in patients with type 2 diabetes and established cardiovascular disease.⁷

The Bottom Line

GLP-1s and SGLT-2s are both potent allies in reducing cardiovascular risk—but matching the right agent to the right patient is where the value lies. As GLP-1s gain attention (and prescription volume), clinical discernment matters more than ever. These drugs aren’t cure-alls—but when used strategically, they’re powerful tools for prevention.

Now is the time to act—not when the costs are already baked in. It’s time to listen to the warning shot. It’s time to call in the specialists at Prodigy.

By Lexy MacArthur

PharmD Candidate (P4)

LinkedIn

E-mail: pharmd@prodigyrx.com

Citations

1. https://pmc.ncbi.nlm.nih.gov/articles/PMC7744318/

2. https://www.nejm.org/doi/full/10.1056/NEJMoa1607141

3. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)31149-3/abstract

4. https://www.ahajournals.org/doi/10.1161/CIR.0000000000000973

5. https://www.nejm.org/doi/full/10.1056/NEJMoa2307563

6. https://www.ahajournals.org/doi/10.1161/cir.0000000000000678

7. https://www.mdpi.com/2308-3425/10/8/322