Experts Encourage Use of GLP-1s in Cardiovascular Care

The last day of the ASPC 2025 Congress on CVD Prevention saw attendees sticking around to attend the final sessions of the weekend, including a session that focused on the use of glucagon-like peptide-1 (GLP-1) inhibitors in cardiovascular care. According to expert presenters, the results of previous studies have shown a remarkable benefit of using GLP-1s to reduce the number of cardiovascular events experienced by those at risk.

GLP-1s should be used consistently in cardiology care according to experts | Image credit: Fernanda - stock.adobe.com

Vinita Aroda, MD, director of diabetes clinical research at Harvard Medical School, opened the session by describing the evolution of GLP-1s over the years, starting in 2005 with Exenatide BID, where patients saw about 2 pounds of weight loss and flattening of blood glucose level,¹ and continuing through 2019, where oral semaglutide showed that it could preserve the efficacy of semaglutide.²

“Then came the combination tirzepatide [glucose-dependent insulinotropic polypeptide] and GLP-1 receptor agonist, which again has opened up a new wave of another unfolding, so to speak,” said Aroda. “For the first time, we saw that more than 50% of people achieved an [hemoglobin] A_1c less than 5.7.”

Recent studies into the effects of GLP-1s on cardiovascular events have also been promising, with a meta-analysis from 2024 showing that the odds of major adverse cardiac events and all-cause mortality were reduced after patients took GLP-1s compared with placebo.³ In the past, these differences would be seen after around 12 years compared with more recent studies. “We’re starting to see an earlier separation that occurs that can ask the question of whether there’s something special about these agents,” Aroda said as she demonstrated the separation occurring as early as 6 months after starting new agents.

She also presented data on how trizepatide and semaglutide led to reductions in weight as well as reductions in heart failure–related symptoms in patients who were diagnosed with type 2 diabetes and heart failure with preserved ejection fraction,^4,5 emphasizing that the results were promising not just for the cardiovascular results but also for the effects throughout.

When it comes to offering GLP-1s to patients, Aroda said that clinicians should discuss the medication with the patient by emphasizing the goals of decreasing the risk of heart and kidney disease and optimizing long-term health and explaining what the patient should expect after starting the medication. Explaining that the patient should remain hydrated and introduce muscle resistance training is also vital, she said.

“It isn’t about getting to the highest dose fast enough or maximum efficacy. It’s understanding the patient in front of you, educating, escalating to an appropriate dose, acknowledging the potential effects, and modifying to the patient,” Aroda concluded.

Darren McGuire, MD, MHSc, distinguished teaching professor of medicine at University of Texas Southwestern Medical Center, encouraged cardiologists to use GLP-1s in their practice given this data, as most cardiology clinics in the US are only prescribing these medications in the single digits, despite the decade of data.

“We have 3 medications, injectable, that have FDA product label indications. And these have unequivocally entered the guidelines, both the endocrinology guidelines you saw from [Aroda] earlier but also our cardiology guidelines, most recently the European Society for Cardiology guidelines from 2023. So these are now unequivocally endorsed as level 1a cardiovascular medications,” he said.

McGuire shared the results of the SOUL⁶ and SURPASS⁷ trials, which found that oral semaglutide reduced the number of cardiovascular events when compared with placebo and that tirzepetide was non-inferior to dulaglutide for 3-point major adverse cardiovascular events, respectively. The SOUL trial also demonstrated reduced rates of hospitalization for acute and chronic limb ischemia when using oral semaglutide whereas the SURPASS trial demonstrated all-cause mortality was 16% lower in those who took tirzepetide compared with dulaglutide.

When it comes to cardiovascular use specifically, he pointed out the SUMMIT trial,⁵ which found that tirzepatide was able to decrease the cumulative incidence of death from cardiovascular causes or a worsening heart-failure event when compared with placebo over the course of 136 weeks, with separation in outcomes starting as early as 24 weeks.

GLP-1s have expanded in use beyond diabetes and obesity, said McGuire, with researchers continuing to expand the use of the drugs to kidney disease, heart failure with preserved ejection fraction, and metabolic associated liver disease. Because many of those indications can affect cardiovascular disease, the use of GLP-1s is vital in cardiology.

“These have to become part of our usual arsenal. We have guidelines and professional society endorsements. These should immediately impact care, not just in the endocrinology clinics and not just in primary care, but in the cardiology clinic,” he concluded.

References

1. Aroda VR. A review of GLP-1 receptor agonists: evolution and advancement, through the lens of randomized controlled trials. Diabetes Obes Metab. 2018;20 Suppl 1:22-33. doi:10.1111/dom.13162

2. Aroda VR, Rosenstock J, Terauchi Y, et al; PIONEER 1 Investigators. PIONEER 1: randomized clinical trial of the efficacy and safety of oral semaglutide monotherapy in comparison with placebo in patients with type 2 diabetes. Diabetes Care. 2019;42(9):1724-1732. doi:10.2337/dc19-0749

3. Rivera FB, Cruz LLA, Magalong JV, et al. Cardiovascular and renal outcomes of glucagon-like peptide 1 receptor agonists among patients with and without type 2 diabetes mellitus: a meta-analysis of randomized placebo-controlled trials. Am J Prev Cardiol. 2024;18:100679. doi:10.1016/j.ajpc.2024.100679

4. Kosiborod MN, Abildstrøm SZ, Borlaug BA, et al; STEP-HFpEF Trial committees and Investigators. N Engl J Med. 2023;389:1069-1084. doi:10.1056/NEJMoa2306963

5. Packer M, Zile MR, Kramer CM, et al; SUMMIT Trial Study Group. Tirzepatide for heart failure with preserved ejection fraction and obesity. N Engl J Med. 2025;392:427-437. doi:10.1056/NEJMoa2410027

6. McGuire DK, Busui RP, Deanfield J, et al. Effects of oral semaglutide on cardiovascular outcomes in individuals with type 2 diabetes and established atherosclerotic cardiovascular disease and/or chronic kidney disease: design and baseline characteristics of SOUL, a randomized trial. Diabetes Obes Metab. 2023;25(7):1932-1941. doi:10.1111/dom.15058

7. Lilly’s Mounjaro (tirzepatide), a GIP/GLP-1 dual agonist, demonstrated cardiovascular protection in landmark head-to-head trial, reinforcing its benefit in patients with type 2 diabetes and heart disease. News release. Lilly. July 31, 2025. Accessed August 3, 2025. https://investor.lilly.com/news-releases/news-release-details/lillys-mounjaro-tirzepatide-gipglp-1-dual-agonist-demonstrated