Can Weight Loss Drugs Like Wegovy® & Zepboundtm Help Afib?
February 26, 2024
Atrial fibrillation is a widespread and growing concern, with over 5 million Americans estimated to be suffering from the condition. From anecdotal evidence, there may be far more than this number. While Afib itself is rarely dangerous unless you have significant underlying cardiovascular disease, the consequences of untreated or undertreated Afib include a five times increased risk of stroke and a significantly increased risk of heart attack. Over the long term, there is an increased risk of congestive heart failure as the heart essentially tires out with all the excess and erratic beats.
But can a new class of weight loss drugs – Semaglutides (Wegovy®) and Liraglutides (ZepboundTM) or GLP-1 receptor agonists, be the answer or at least improve the symptoms of atrial fibrillation? The short answer is, possibly. Let’s dig a little deeper:
Part of the reason why Afib has been on the rise in the adult population of the United States stems from the significant upward trend in excess weight and obesity that we have seen over the past few decades. Today, over 30% of the adult population is obese, and more than 2/3 are overweight. As you may already know, lifestyle issues, such as poor diet and lack of exercise, are significant risk factors for developing or worsening Afib. But should these drugs be a part of the Afib continuum of care?
A recent study has shown that these weight loss drugs, injected weekly into the abdomen, reduce the incidence of major cardiac events by 20%1 and the risk of significant cardiac events by the same amount. This stands to reason, as metabolic diseases resulting from excess weight are important in cardiovascular issues.
But Are They the Only or Best Answer?
It’s important to look at atrial fibrillation holistically, and no single factor contributes to the development or worsening of Afib. Rather, it is a constellation of issues that may be at play. We often talk about stress-related concerns that underlie some cases of Afib. These may also be at the heart of excess weight. As such, even if medication is taken to lose weight, the underlying stress has not been addressed.
Remember that not all patients will derive a significant weight loss benefit from these drugs. Some will also experience considerable side effects that may not allow them to continue medication. These side effects may include nausea, vomiting, pancreatitis, gallbladder disease, possible gastric motility issues, and more. For many experiencing comorbidities associated with excess weight, the significant benefits may outweigh these potential risks.
We also must consider the long-term viability of taking these drugs. This is especially true for middle-aged and younger patients. We do not have data on the long-term effects of taking GLP–1s. As such, patients must be diligent about changing their diet and exercise habits while on the medication in case they do eventually have to discontinue them. As many already know, the cost is also a prohibitive factor here until insurance coverage is more consistent.
For the millions who already have Afib, losing weight, whether through traditional diet and exercise or taking these drugs, can be very beneficial but may not be enough to eliminate their episodes and risks. This is especially true for patients who are experiencing persistent Afib. At this point, being under the care of an electrophysiologist like Dr. Banker is particularly important as procedural options like cardiac catheter ablation are very effective in the well-selected patient, often offering a permanent solution to Afib.
Resources:
- BMJ 2023; 383 doi: https://doi.org/10.1136/bmj.p2668 (Published 13 November 2023)Cite this as: BMJ 2023;383:p2668
