My doctor wants to put me on semaglutide but I've heard it causes heart problems. Is that true?

The concern about semaglutide causing heart problems is not supported by the clinical trial evidence, the direction of evidence is the opposite. The LEADER trial (liraglutide, 2016), SUSTAIN-6 trial (semaglutide, 2016), and SELECT trial (semaglutide, 2023) all demonstrated cardiovascular benefit, not harm. The claim that "these drugs haven't been around long enough to know what they do to your heart" was understandable in 2018. By 2026, the cardiovascular outcomes literature for this drug class includes over 50,000 patient-years of randomized trial data. "We don't know yet" is chronologically inaccurate.

The one legitimate cardiac monitoring point: GLP-1 receptor agonists increase resting heart rate by approximately 2–4 bpm through direct sinoatrial node receptor activation. In the SELECT trial, this increase was observed and was not associated with worse outcomes, it is a pharmacological effect, not a sign of damage. For men with pre-existing heart rate conditions, significant autonomic dysfunction, or heart failure with reduced ejection fraction, this small chronotropic effect warrants clinical discussion. But in otherwise healthy post-MI patients with elevated BMI: the evidence is in the direction of benefit, not harm. (Lincoff et al., NEJM, 2023)

Cardiologist's calibrated position, Solid (1) that semaglutide does not cause cardiovascular harm in the studied populations, and in fact reduces cardiovascular events.

What to do: Bring the SELECT trial to your conversation with your doctor. The specific objection, that "we don't know what it does to the heart", has a direct answer: the SELECT trial is that answer.

For the full picture, read The Drug That Surprised Cardiologists.