Are Weight Loss Drugs the Answer to Our Afib & Heart Health Issues?
July 26, 2023
Unfortunately, heart disease remains stubbornly prevalent in the United States and worldwide. Cardiovascular issues remain the leading cause of death in the United States despite incredible advances in therapies and technologies to treat heart disease. Cardiovascular disease has many possible underlying causes, but one of the most preventable and prevalent is excess weight and obesity. About 2/3 of the US population is overweight, and over 1/3 is obese. These trends have risen over the past several decades; unfortunately, we don’t see much relief.
The effects on the heart are staggering. Excess weight causes high blood pressure, high cholesterol, sleep apnea, and type 2 diabetes, all significant risk factors for developing or worsening cardiovascular disease. Many are also risk factors for atrial fibrillation / Afib and other heart rhythm abnormalities.
So, What Is Being Done to Manage This Concern?
As we collectively gain more weight, managing that weight through diet and exercise becomes even more complex. There are thousands of diets on the marketplace ranging from low fat to low carb, highly restrictive to “eat just about anything.” The one problematic feature that most of these diets share is that they are often unsustainable. Most patients who start a diet may be able to lose a significant amount of weight, but ultimately once they come off the diet and return to their former eating habits, they regain all that weight and sometimes even more. It becomes a vicious cycle.
In the past, we have looked to weight loss medications and supplements as an answer. However, these have had a somewhat checkered history. Some drugs have led to problematic side effects and even death. Even today, certain supplements with questionable safety and efficacy profiles are being sold as there is very little governmental oversight. Another alternative has traditionally been weight loss (bariatric) surgery; however, due to the more invasive nature of this option, adoption has been relatively slow, with only about 1 to 2% of people eligible for surgery having the procedure.
Enter Weight Loss Drugs of 2022
If you’ve been following the news over the past several months, you’ll likely have heard about new weight loss drugs known as GLP-1 agonists or semaglutides. An injectable drug by the name of Wegovy is one such option and has shown significant effectiveness in the management of excess weight. Some patients report up to 15% body weight loss after taking this drug. The results have been so good that it and its sibling Ozempic, a drug with the same active ingredients approved only for type 2 diabetes management, have been in short supply for months. As we write this, new injectable drugs and similar pill-form options are in the approval stages.
Will They Change the Tide in Heart Disease?
The evidence for the efficacy of these drugs is clear. People are losing significant weight with a relatively low side effect profile. Of course, this is not to say that there aren’t longer-term risks that we still don’t know about, and as such, this should be discussed with your physician or metabolic expert. However, losing weight does typically help with overall cardiovascular risk and the risk of cardiac arrhythmias like Afib. Remember, however, that weight loss and lifestyle change alone typically will not fully resolve Afib, and as such, if you are experiencing any episodes, even paroxysmal or occasional, it’s important that you visit an electrophysiologist like Dr. Tordini.
There Are, of course, Considerations
First, these drugs are only helpful if the patient takes them. As such, Dr. Tordini views them as a good interim option for the appropriate patient as long as patients understand the need to change their lifestyle to maintain the results longer-term. This means improving what they eat – eliminating saturated fats, sugars, and simple carbs and replacing them with healthier options. It also means that patients must start or maintain an appropriate exercise schedule. Rapid weight loss without exercise often leads to muscle mass declines and muscle wasting. Also, there is concern about possible bone mass loss and longer-term osteoporosis risk, especially in middle age and older female patients.
What’s the Verdict?
As with any new medication, there’s a lot we will learn in the coming months and years as real-life, wide adoption adds context to clinical trial results. For now, patients can speak to their primary care physician, endocrinologist or cardiologist, or any qualified weight-loss specialist to discuss the possibility of using medication to prevent or minimize the worsening of heart disease.
In the meantime, do not delay seeking appropriate electrophysiological care if you are experiencing any abnormal heart rhythm issues, including Afib. Contact us to schedule a consultation with Dr. Tordini.