In a pharmacy you see boxes of Ozempic and Wegovy manufactured by Novo Nordisk.
Hollie Adams | Reuters
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GLP-1s are practically everywhere: about 1 in 8 American adults takes one.
But stopping those medications can come at a cost.
This is according to a new study from the University of Washington School of Medicine, which was published Wednesday in BMJ Medicine.
The research found that even short intervals in GLP-1 treatment can increase the risks of heart attack, stroke and death in patients with type 2 diabetes, and the impact may not be completely reversible. Using electronic medical records, researchers followed more than 333,000 adults with diabetes for three years, and most of them took NordiskOzempic diabetes injection.
These are the key data points:
- Patients who continued taking GLP-1 for three years experienced an 18% reduction in cardiovascular risk.
- Stopping GLP-1 for just six months removed much of that protection, increasing the risk by 4% compared to continuous use.
- A two-year gap in treatment raised that risk to 22% compared with sustained use.
GLP-1s do “much, much more than just lose weight,” study author Dr. Ziyad Al-Aly, an epidemiologist at WashU Medicine, said in an interview. “They're reducing all of these back problems, lowering cholesterol, lowering blood pressure, reducing insulin resistance, reducing inflammation and really offering cardiovascular protection.
“When people stop taking GLP-1, that cardiovascular protection ceases to exist and, what's more, there is some asymmetry here,” he added. “It takes years to build cardiovascular protection, and it takes half as long to undo it.”
Al-Aly called it “metabolic whiplash,” in which all improvements “go in the wrong direction” after treatment ends.
The findings are not entirely a surprise.
GLP-1 are well known for their cardiovascular benefits. In 2024, the Food and Drug Administration approved semaglutide, the active ingredient in Novo Nordisk's Wegovy and Ozempic, to dramatically reduce the risk of major cardiovascular events in adults with established heart disease and obesity.
But the new study offers some of the first large-scale evidence of what happens to patients' hearts when they stop taking these drugs, particularly among those with diabetes.
The research also highlights a persistent problem – high rates of medication abandonment, due to problems accessing them and side effects such as nausea and vomiting – that the healthcare system has yet to fully resolve. According to various studies, GLP-1 discontinuation rates vary between 36% and 81%.
Al-Aly said providers and patients contemplating GLP-1 should understand that people need to follow the treatment “long-term,” not just for a few months or even years.
It also noted the need to address the main drivers of disruptions, such as proactively mitigating side effects. The access problem is likely to improve in the United States, especially as big players like Eli Lilly continue efforts to increase coverage of obesity medications among employers, and as the federal Medicare program prepares to begin covering weight loss treatments for the first time.
Keeping patients on treatment “should not be an afterthought,” he said. “People need to realize that stopping has a price.”
Drug manufacturers are also working to solve the discontinuation problem, hoping to develop next-generation treatments for obesity and diabetes that provide comparable effectiveness with fewer unwanted side effects.
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