ACC Advocates Early Medication Use for Obesity to Boost Cardiovascular Health

For patients with obesity, clinicians should move beyond a "try and fail" approach to lifestyle interventions and prioritize weight management medication when it can deliver crucial cardiovascular benefits. | Image Credit: zhuan - stock.adobe.com

Clinicians should consider weight management medications, like semaglutide and tirzepatide, as a primary treatment option for eligible patients with obesity who may benefit from cardiovascular risk reduction, emphasizing their proven efficacy over lifestyle interventions alone and the need to address access disparities, based on a Concise Clinical Guidance (CCG) document issued by The American College of Cardiology (ACC).¹

Obesity, a chronic, progressive disease that affects over 1 billion people worldwide, can lead to severe cardiovascular complications. Dyslipidemia, type 2 diabetes, hypertension, and sleep disorders can all directly relate incident cardiovascular risk factors to obesity.² The disease is multifactorial with a complex pathogenesis related to biological, psychosocial, socioeconomic, and environmental factors, and it shows heterogeneity in the pathways and mechanisms by which it leads to adverse health outcomes.

Obesity also reduces life expectancy significantly (9.1 years in men vs 7.7 years in women).¹ Treatment is especially essential, but not all weight loss methods are effective.

Modern obesity medications, including semaglutide (Ozempic/Wegovy) and tirzepatide (Mounjaro/Zepbound), have proven more effective than lifestyle interventions. They not only facilitate weight loss but also reduce overall cardiovascular disease risk with fewer dangers than procedure-based interventions.

However, significant disparities and low prescribing rates of semaglutide and tirzepatide for obesity from 2021 through 2024 highlight potential links to the social factors of race, ethnicity, social vulnerability, and urbanicity.³ These issues, along with underutilization, demand careful monitoring of both evolving prescribing practices for these medications and potential contributions from policy and reimbursement strategies.

Prior guidelines recommended trying lifestyle interventions before beginning medication, but this new guidance recommends considering these medications as a first-line treatment option for eligible patients.¹

“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,” Olivia Gilbert, MD, MSc, FACC, chair of the CCG and a cardiologist at Atrium Health Wake Forest Baptist Medical Center stated in a press release.⁴

The new guidance outlines the clinical decision-making process for clinicians to incorporate pharmacologic weight management strategies into cardiovascular care.¹ Key areas include rationale and eligibility, which clinicians may determine by body mass index thresholds or other risk indicators. Clinicians can adjust these therapies to minimize adverse effects and personalize care.

Additionally, clinicians should consider pharmacological options because semaglutide and tirzepatide have demonstrated the highest efficacy, but data support slightly greater weight loss with tirzepatide. Insurance coverage, availability, and affordability will likely dictate agent selection as well.

Other key areas to consider include potential impacts on cardiovascular risk because clinical evidence supports medications that lead to a reduction in major adverse cardiovascular events, including cardiovascular death, myocardial infarction, and stroke, particularly in individuals with type 2 diabetes and elevated cardiovascular risk. Clinicians should also consider multidisciplinary care approaches, since coordinated care can help assess modifiable risk factors, identify comorbidities, and tailor treatment strategies.

The guidance also emphasizes person-first language, promotes welcoming clinical environments, and addresses weight stigmas to reduce bias and improve patient experiences. Clinicians should focus on validating the lifelong journey that patients experience with this chronic disease.

Lastly, the lack of insurance coverage remains a major barrier for patients. Initial strategies to improve access to therapies include identifying individuals most likely to benefit, closely monitoring treatment outcomes, and negotiating prices. Experts emphasize that the US should work toward continually improving access to these therapies.

“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,” Gilbert said.⁴

References

1. Gilbert O, Gulati M, Gluckman TJ, et al. 2025 Concise Clinical Guidance: an ACC expert consensus statement on medical weight management for optimization of cardiovascular health. J Am Coll Cardiol. Published online June 2025. doi:10.1016/j.jacc.2025.05.024
2. ‌Powell-Wiley TM, Poirier P, Burke LE, et al. Obesity and cardiovascular disease: a scientific statement from the American Heart Association. Circulation. 2021;143(21):984-1010. doi:10.1161/cir.0000000000000973
3. Shaw ML. Access to semaglutide, tirzepatide for obesity not equal for all. The American Journal of Managed Care^®. April 29, 2025. Accessed June 19, 2025. https://www.ajmc.com/view/access-to-semaglutide-tirzepatide-for-obesity-not-equal-for-all
4. New ACC concise clinical guidance report ‘weighs in’ on medical weight management for optimizing CV health. News release. American Academy of Cardiology. June 20, 2025. Accessed June 20, 2025. https://www.acc.org/Latest-in-Cardiology/Journal-Scans/2025/06/20/13/28/New-ACC-Concise-Clinical-Guidance-Report