Large study links stopping GLP-1 drugs to heart risk

The researchers compared the annual rates of nonfatal heart attacks, nonfatal strokes and deaths between the groups. The combined outcome occurred in about four of every 100 people who stopped treatment each year, versus roughly two of every 100 who continued.

Deaths from any cause also occurred more often among people who stopped treatment. That difference was particularly pronounced among participants with obesity.

In routine care, the group that stopped GLP-1 treatment had worse heart and stroke outcomes than the group that continued.

Could weight, blood sugar or blood pressure explain the difference?

GLP-1 medicines, including Ozempic, help control blood sugar and can support substantial weight loss. Some also reduce the risk of cardiovascular complications in certain patients, although that benefit does not apply uniformly to every person taking the drug class.

After discontinuation, changes in body weight, blood sugar and blood pressure were relatively modest. Those measures alone did not appear to explain the substantial difference in outcomes.

The analysis therefore did not point to short-term changes in these three measures as a complete explanation for the gap.

Does the study show that stopping causes harm?

This was an observational study. Researchers tracked what happened during routine care instead of randomly assigning patients to stop or continue medication.

That design can reveal strong associations, but it cannot guarantee that the medication caused the difference. People who discontinued treatment may already have been sicker than those who continued.

Researchers also could not reliably determine why each person stopped. Common reasons for discontinuation include:

• Side effects
• Cost
• Access problems
• Other health concerns

The unusually large difference in death rates makes those limitations especially important. It would be misleading to assume that stopping a GLP-1 medicine directly doubles an individual’s cardiovascular risk.

Further research must separate the effects of discontinuation from differences in underlying health and other reasons for stopping. For now, the findings show a strong association, not proof that stopping treatment itself caused the extra events.

What should patients do before changing treatment?

The findings reinforce the need to plan long-term diabetes treatment with a clinician. Continuity of care may be an important part of maintaining the benefits associated with GLP-1 medicines.

Patients should discuss three issues before changing a prescribed treatment:

• Possible side effects
• Affordability
• Alternative medicines

People should not stop a prescribed drug on their own. Addressing the reasons that make treatment difficult may help prevent avoidable gaps in care, although the study cannot yet determine whether such changes would reduce cardiovascular events.

For now, the practical message is to review long-term treatment plans with a clinician before stopping GLP-1 therapy.