Do Weight Loss Medications Like Wegovytm Benefit Afib Patients?

If you follow the news and social media, you’ve undoubtedly seen the meteoric rise in (and shortage of) GLP-1 agonist medications, usually administered via injection into the stomach, like WegovyTM. This medication, also known as Semaglutide, has shown exceptional weight loss potential by targeting certain metabolic functions, leading to less hunger and consequent weight loss. Semaglutides’ rise started as a treatment for Type-2 diabetes known as OzempicTM. Not only was it very effective in this capacity, but significant weight loss was seen in patients taking the drug. Wegovy, a higher-dose version of Ozempic, was approved by the FDA last year for weight loss.

Having researched atrial fibrillation, and its causes, you may know that a significant risk factor for de novo or worsened Afib and cardiac arrhythmias, in general, revolves around lifestyle, specifically diet. As the quality of our collective diets has progressively declined, with more and more Americans classified as overweight and obese, the incidence of heart palpitations and other metabolic diseases like type-2 diabetes, high cholesterol, and high blood pressure have all proliferated.

Can Weight Loss Medication Help?

The short answer is that we don’t know. While it stands to reason that losing weight and improving one’s diet would mitigate or even reverse some cardiovascular concerns that metabolic issues may cause, every person is different. Results also depend on how long cardiovascular problems have existed and their severity. For example, while lifestyle change may improve the recent onset of Afib, patients with persistent or long-standing persistent Afib may not see the same improvement. There are also some other considerations of these medications:

• First, losing weight and improving diet is only half the battle against metabolic and cardiovascular issues. Patients must also be aware that as they lose a significant amount of weight, they will also lose muscle mass and potentially some bone density. This is especially true in middle-aged and older female patients, and this can be mitigated with proper exercise and protein and calcium intake. Be sure to speak to your primary care, physician or knowledgeable medical professional about how best to manage your weight loss.
• Secondly, as with most medications, they only work while taking them. This new class of drugs is indicated only for certain obese patients, while others typically pay for the medicine and receive it via off-label prescription from their doctor. On the one hand, insurance coverage may be finite. On the other hand, continuous cash payment for this medication may not be possible for all. As such, lifestyle change while taking these medications is critically important. In other words, patients must take this time to reinforce long-term dietary and exercise choices that they continue even after stopping their medication. Otherwise, they risk losing the weight loss benefit, regaining their weight, and potentially reversing any cardiovascular or metabolic improvements.

Is Weight Loss Universally Good?

With the increase in overweight and obesity in the United States, weight loss has become a critical part of the future health of our country. This was highlighted during the COVID-19 pandemic crisis, where overweight and obese patients almost universally had worse outcomes than those who did not have weight problems.

This increase in weight-related metabolic and cardiovascular concerns also has mainly offset our gains in treating cardiovascular issues. Despite our best efforts, heart disease remains the leading killer of men and women in the United States.

With that said, when necessary, and with the appropriate patients, if weight loss medications like GLP-1 agonists or new medicines in the pipeline are effective, offering sustained and healthy weight loss, the benefits to the heart can be tremendous. We always remind our patients that improved diet and exercise are the basis of good heart health, no matter what intervention is pursued, whether it is weight loss medications or even weight loss surgery.

The five times increased risk of stroke in Afib patients is also a serious concern. Possibly a full third or more of ischemic strokes can be traced back to irregular heartbeats, at least as a contributing factor.¹ So, even if you pursue a weight loss strategy that includes weight loss medications, it’s essential to be under the care of a qualified and knowledgeable electrophysiologist to ensure that you receive the appropriate treatment for this condition and its potential adverse effects.

We encourage you to call us to schedule a consultation with Dr. Moretta and learn more about the treatment options you may have. Dr. Moretta will work with you and your weight management specialist to develop a plan that best suits your circumstances.

Reference:

1. Jaakkola J, Hartikainen P, Kiviniemi TO, Nuotio I, Palomäki A, Hartikainen JEK, Ylitalo A, Mustonen P, Airaksinen KEJ. Distribution of ischemic strokes in patients with atrial fibrillation: The FibStroke Study. Neurol Clin Pract. 2019 Aug;9(4):330-336. doi: 10.1212/CPJ.0000000000000683. PMID: 31583188; PMCID: PMC6745749.