What's the honest verdict on GLP-1 drugs from a cardiologist who has no financial interest in them?

The honest verdict, from a cardiologist with no supplement company equity, no pharmaceutical speaker bureau affiliations, and no financial interest in these drugs: semaglutide is the most rigorously tested cardiovascular risk reduction agent to enter clinical practice in the past decade. The SELECT trial is among the largest and most well-designed cardiovascular outcomes trials ever conducted. A 20% MACE reduction in a high-risk, non-diabetic, post-MI population over 3.3 years is a clinically significant result that cannot be attributed to bias or small study size.

The honest caveats: the weight loss is not durable without continued treatment; lean mass loss requires active mitigation; the drugs cost more than most patients can sustain without insurance; and the primary prevention evidence does not yet exist in the same form. The honest endorsement: for a man who has had a cardiac event, carries elevated BMI, has tried lifestyle modification for 12–18 months without sufficient metabolic normalization, and has no specific contraindications, the evidence supporting GLP-1 therapy as part of his cardiovascular secondary prevention plan is as strong as the evidence for any drug I prescribe in clinical practice. The men who would benefit most from this drug are often the men most confused by the noise around it. This is the cardiologist's role: to translate the noise into clinical signal. (Lincoff et al., NEJM, 2023)

Cardiologist's calibrated position, Solid (1) for the specific SELECT population. The honest verdict includes the caveats, not just the benefit.

What to do: Make this decision with a cardiologist who has read the SELECT trial, not with a pharmacist, a Reddit thread, or an influencer whose supplement company payments have been publicly documented.

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

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