American College of Cardiology backs weight loss drugs as heart health treatment for obese patients

The American College of Cardiology (ACC) is recommending that clinicians use weight management medications as first-line treatment for obese patients to reduce cardiovascular disease risks (CVD). Its new guideline prioritizes pharmacologic weight management strategies for heart health, supporting the idea that multidisciplinary approaches can help improve therapies.

ACC notes that GLP-1s like semaglutide and tirzepatide are more effective than lifestyle interventions for weight loss and lowering CVD risks. It also claims these medications have fewer risks than procedure-based interventions, contradicting previous guidance recommending patients try lifestyle interventions such as diet and exercise before beginning medication. 

“Patients should not be required to ‘try and fail’ lifestyle changes prior to initiating pharmacotherapy; nonetheless, lifestyle interventions should always be offered in conjunction with obesity medications,” says Olivia Gilbert, MD, MSc, FACC, Chair of the CCG and a cardiologist at Atrium Health Wake Forest Baptist Medical Center.

“Weight management by the cardiovascular community needs to be embraced, given both the prevalence of obesity and the impact it has on many forms of CVD.”

Affecting over 1 billion people globally, obesity can lead to heart complications such as failure, coronary artery disease, and stroke. ACC adds that obesity can lower life expectancy by 9.1 years in men and 7.7 years in women.

Key tips for clinicians

The guidance, published in the Journal of the American College of Cardiology, highlights key areas that can help clinical decision-making, such as weight loss and heart care.

ACC notes that  GLP-1 receptor agonist semaglutide and GLP-1/GIP receptor agonist tirzepatide are FDA-approved and are the most effective.ACC urges that clinicians assess patients’ eligibility for taking these drugs based on BMI (body mass index) or other risk indicators. Additionally, it encourages that therapies be personalized to the individual to minimize adverse side effects.

GLP-1 receptor agonist semaglutide and GLP-1/GIP receptor agonist tirzepatide are FDA-approved and are most effective, ACC notes. Studies have shown that tirzepatide has a slightly greater effect on weight loss. 

However, ACC advises that clinicians consider insurance coverage, availability, and affordability. It also notes a need to improve access to these therapies in the US.

ACC adds that clinical evidence shows the medications lead to a significant reduction in cardiovascular death, myocardial infarction, and stroke, especially in people with type 2 diabetes and those with higher cardiovascular risk.

The guidance underscores the importance of “team-based approaches” for weight management, as they can help assess modifiable risk factors, identify comorbidities, and tailor treatment strategies. 

Weight loss conversations can demotivate patients, so ACC also highlights the need to create a welcoming environment with person-first language to address weight stigmas.

Nutrition link to GLP-1s

A previous study found that medical schools do not sufficiently train clinicians on nutrition, which carries risks to patients. “Mainstream medicine is still very focused on linking weight to health,” says Kearney Gunsalus, lead author of the paper and an assistant professor at the Augusta University/University of Georgia Medical Partnership.

ACC claims weight loss medications have fewer risks than procedure-based interventions.Dr. Ellen House, co-author and an associate professor at the Medical Partnership, adds that if benefits arise independent of weight loss, physicians should shift conversations with patients to emphasize health over weight loss.

Meanwhile, GNC revealed that people on GLP-1 medications often have poor diet quality, consume insufficient protein per body weight, and are deficient in fiber, calcium, iron, magnesium, potassium, choline, and vitamins A, C, D, and E.

Recently, four US organizations developed the advisory “Nutritional Priorities to Support GLP-1 Therapy for Obesity” to help clinicians support patients on these medications for weight management with evidence-based nutritional and behavioral strategies.

A report by IFF this month details how the rapidly growing GLP-1 weight loss consumer market is reshaping sensory food and beverage formulations as brands are adapting to the nutritional needs associated with these rapid weight loss therapies.