A large US study indicates that stopping and restarting GLP-1 receptor agonists like semaglutide diminishes their cardiovascular benefits for type 2 diabetes patients, with risks increasing the longer treatment is interrupted.
A large study of more than 330,000 people with type 2 diabetes suggests that the cardiovascular protection linked to GLP-1 medicines such as semaglutide weakens when treatment is interrupted for long periods, according to research published in BMJ Medicine.
The study, led by researchers at Washington University School of Medicine in St Louis and based on US Veterans Affairs health records, followed 333,687 patients for up to three years. It compared people who stayed on GLP-1 receptor agonists with those who stopped and later restarted, or discontinued treatment altogether, then looked at major adverse cardiovascular events, including heart attack, stroke and death. The analysis found that continuous use for three years was associated with an 18% lower risk of major cardiovascular events than treatment with sulphonylureas, another class of diabetes drug.
The gaps widened as interruptions lengthened. Compared with patients who kept taking GLP-1 therapy, those who restarted after a six-month break had a 4% to 8% higher risk of major cardiovascular events, while the increase was 14% after a year off treatment and 22% after two years. Patients who resumed therapy after a period of stopping still appeared to benefit, but less than those who remained on the drugs throughout the study period.
The findings are in line with a broader body of cardiovascular research on GLP-1 medicines. A review in Nature Reviews Cardiology has described these drugs as helping not only blood sugar control but also weight, blood pressure and inflammation, all of which can contribute to lower cardiovascular risk in people with type 2 diabetes. Other BMJ research has also suggested that combining GLP-1 drugs with SGLT-2 inhibitors may further reduce major cardiovascular and kidney events.
Even so, the authors and outside observers would caution against over-reading the result. The study was observational, so it can show an association but not prove that stopping treatment directly caused more heart attacks or strokes. The cohort was also older, mostly male and limited to people with type 2 diabetes, meaning the results cannot simply be extended to people taking semaglutide or similar medicines only for weight loss. In that setting, the cardiovascular benefits may differ and still require separate study.
Disclaimer: This content is for informational purposes only and is not intended to be a substitute for professional medical judgment, advice, diagnosis, or treatment.
