Hormonal
Semaglutide and tirzepatide reduce cardiovascular risk and improve cardiac function through pleiotropic mechanisms including endothelial protection, anti-inflammation, and inhibition of cardiomyocyte apoptosis, independent of glycemic control.
If you have obesity and existing heart disease, semaglutide (2.4 mg weekly) significantly lowers your risk of heart attack, stroke, and cardiovascular death, even if you do not have diabetes. This benefit comes from direct protection of your blood vessels and heart muscle, not just weight loss.
Incretins can be classified as disease-modifying therapy drugs, since they affect the cardiovascular system, improving the functional state of the endothelium, reducing blood pressure, slowing platelet aggregation, inhibiting cardiomyocyte apoptosis, improving glucose utilization, and exerting a vasodilating effect. This explains the reduction in the risk of cardiovascular complications observed in clinical studies, and in experimental studies, a decrease in the necrosis zone during modeling of myocardial infarction and the use of incretin mimetics.
Why this rating
The paper cites large-scale randomized clinical trials (SUSTAIN-6, SELECT) with statistically significant primary endpoints (MACE reduction).
Source
Cardiovascular effects of semaglutide and tirzepatide and their potential for cardioprevention
D. V. Cherkashin et al. · Meditsinskiy sovet = Medical Council · 2025
DOI 10.21518/ms2025-323
Related findings · Hormonal
- Initial treatment for type 2 diabetes should be a combination of metformin and either an SGLT-2 inhibitor or a GLP-1 receptor agonist to achieve cardiorenal protection, rather than monotherapy or older agents like sulfonylureas.Strong
- For patients with specific monogenic obesity syndromes (leptin deficiency, POMC/PCSK1/LEPR mutations), targeted pharmacotherapy (recombinant leptin or setmelanotide) is highly effective and should be prioritized, unlike in polygenic obesity.Strong
- Continued weekly administration of 2.4 mg subcutaneous semaglutide prevents weight regain and promotes further weight loss in adults with overweight or obesity, whereas switching to placebo results in significant weight regain.Strong
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