Ozempic, Mounjaro, and Cardiovascular Health

# Ozempic, Mounjaro, and Cardiovascular Health

 

Introduction

Ozempic (semaglutide) and Mounjaro (tirzepatide) are glucagon-like peptide-1 (GLP-1) receptor agonists primarily used to treat type 2 diabetes. They have gained significant attention for their role in weight loss and potential cardiovascular benefits. This article examines the medical studies concerning the effects of these medications on stroke and cardiovascular risk, their potential impact on lifespan, and any associated risks.

 

Ozempic and Cardiovascular Risk Reduction

 

Clinical Trials and Real-World Data

Several studies have investigated the cardiovascular benefits of Ozempic. The SUSTAIN-6 trial [1] demonstrated that Ozempic reduced the risk of major adverse cardiovascular events (MACE), including cardiovascular death, nonfatal heart attack, and nonfatal stroke, by 26% in patients with type 2 diabetes. This finding led to FDA approval of Ozempic for cardiovascular disease risk reduction in patients with type 2 diabetes and established cardiovascular disease in 2020 [2].

 

A more recent study, the SELECT trial [3], evaluated the effects of semaglutide 2.4 mg in individuals who were overweight or obese and established cardiovascular disease but without diabetes. The results showed a 20% reduction in MACE, further supporting the cardiovascular benefits of semaglutide. Notably, the SELECT trial also demonstrated a 19% lower rate of all-cause death in patients assigned to semaglutide versus placebo [3], providing strong evidence for the medication's potential to extend lifespan, especially in individuals with obesity and cardiovascular disease.

 

It is worth noting that Wegovy, another medication containing semaglutide as its active ingredient, has also received FDA approval for reducing the risk of major adverse cardiovascular events in adults with obesity or overweight [4]. This further strengthens the evidence for the cardiovascular benefits of semaglutide.

 

Real-world data analysis by Dandelion Health [2] also suggests that GLP-1 drugs, including Ozempic, could prevent up to 34,000 strokes and heart attacks annually in the US. Their AI-driven algorithms, analyzing diverse medical data, indicated a 15-20% reduction in MACE in patients taking GLP-1s.

 

Furthermore, a study presented at the American Heart Association's Scientific Sessions 2024 [5] indicated that GLP-1 agonists, like Ozempic, and SGLT2 inhibitors may help lower the risk of a second stroke or heart attack in stroke survivors. This research analyzed data from over 7,000 adults who had an ischemic stroke and found that those taking either a GLP-1 or SGLT2 medication had a 74% lower mortality risk and an 84% lower risk of having a heart attack compared to those not taking these drugs.

 

Mechanisms of Action

While the exact mechanisms by which Ozempic reduces cardiovascular risk are not fully understood, several factors may contribute:

 

Weight loss: Ozempic promotes weight loss, a significant risk factor for cardiovascular disease [6].

 

Improved blood sugar control: Ozempic helps regulate blood sugar levels, reducing the risk of complications associated with diabetes, including cardiovascular disease [1].

 

Lowering blood pressure: Studies suggest Ozempic may help lower blood pressure, further contributing to cardiovascular protection [7].

 

Improved cholesterol levels: Some studies indicate that Ozempic may improve cholesterol levels, potentially reducing the risk of atherosclerosis [7].

 

Reduced platelet aggregation: Ozempic may decrease platelet aggregation, potentially lowering the risk of blood clots and stroke [7].

 

Mounjaro and Cardiovascular Benefits

 

Emerging Evidence

Although Mounjaro is a newer medication, studies are emerging that suggest potential cardiovascular benefits. While it is not yet FDA-approved for cardiovascular risk reduction, research indicates that it may offer similar advantages to Ozempic.

 

The SUMMIT trial [8] investigated the effects of tirzepatide in adults with heart failure with preserved ejection fraction (HFpEF) and obesity. The study found a 38% reduction in the combined risk of cardiovascular death and worsening heart failure events in participants taking tirzepatide. Researchers at UC Irvine project Mounjaro could prevent up to 2 million heart attacks and strokes over 10 years based on its weight loss and cardiovascular risk factor effects [9].

 

SURPASS Trials

The SURPASS trials [10] further support Mounjaro's efficacy and safety in treating type 2 diabetes. These Phase 3 trials compared Mounjaro to placebo, semaglutide, and insulin degludec in patients with inadequately controlled type 2 diabetes. The results consistently demonstrated Mounjaro's superior ability to lower HbA1c and promote weight loss compared to other treatments.

 

Shared Mechanisms of Action

Mounjaro shares a mechanism of action similar to that of Ozempic, acting as a GLP-1 receptor agonist. However, Mounjaro also activates the glucose-dependent insulinotropic polypeptide (GIP) receptor, potentially enhancing its effects on weight loss and blood sugar control [11]. This dual action may significantly improve cardiovascular risk factors more than Ozempic, which only activates GLP-1 receptors [8].

 

Impact on Lifespan

 

Potential for Increased Longevity

While research directly investigating the impact of Ozempic and Mounjaro on lifespan is limited, some studies suggest these medications may contribute to increased longevity.

 

A study published in the Journal of the American College of Cardiology (JACC) [3] found that individuals taking semaglutide experienced a lower overall mortality rate, including fewer deaths from cardiovascular events and infections. This suggests that Ozempic may have a positive impact on lifespan.

 

Early-Onset Diabetes and Life Expectancy

A study published in Medical News Today [12] highlighted the concerning finding that early-onset type 2 diabetes (diagnosed before age 30) can reduce life expectancy by 14 years. However, the same study also found that Mounjaro is an effective treatment for early-onset diabetes, suggesting its potential to mitigate this life expectancy reduction.

 

Indirect Effects on Longevity

Both Ozempic and Mounjaro indirectly contribute to factors associated with increased lifespan.

 

Reduced risk of chronic diseases: By reducing the risk of cardiovascular disease, diabetes complications, and obesity-related conditions, these medications may contribute to a longer healthspan (the period of life spent in good health) [13].

 

Improved metabolic health: Ozempic and Mounjaro improve metabolic health, linked to longevity [14].

 

Weight management: Maintaining a healthy weight is crucial for longevity, and these medications effectively promote weight loss [13].

 

Potential Risks and Side Effects

 

Common Side Effects

Both Ozempic and Mounjaro share similar side effect profiles, primarily gastrointestinal. The most common side effects include:

 

Side Effect | Ozempic [15] | Mounjaro [16] | Frequency

------------|-------------|---------------|------------

Nausea | ✓ | ✓ | Common

Vomiting | ✓ | ✓ | Common

Diarrhea | ✓ | ✓ | Common

Constipation | ✓ | ✓ | Common

Stomach pain | ✓ | ✓ | Common

Decreased appetite | ✓ | ✓ | Common

 

Serious Side Effects

While generally safe, Ozempic and Mounjaro can cause serious side effects in some individuals. These include:

 

Pancreatitis: Inflammation of the pancreas, a potentially life-threatening condition. Symptoms include severe abdominal pain that may radiate to your back, nausea, and vomiting [15]. Ozempic has been shown to cause pancreatitis in rodents, although it is unclear whether it has the same effect in humans [18]. Mounjaro has also been linked to an increased risk of pancreatitis [17].

 

Gallbladder problems: Increased risk of gallstones and gallbladder disease. This may be because of rapid weight loss, which can increase the risk of gallstones [19]. Symptoms can include pain in the upper abdomen, fever, and jaundice [20].

 

Kidney problems: Dehydration from gastrointestinal side effects, such as severe diarrhea, nausea, or vomiting, can lead to kidney problems, including acute kidney injury [15].

 

Diabetic retinopathy: Worsening of diabetic retinopathy in some patients. This may be due to rapid improvement in blood sugar levels, which can temporarily worsen diabetic retinopathy [22]. Symptoms can include blurred vision, floating spots, and vision loss [22].

 

Thyroid cancer: Ozempic and Mounjaro have a boxed warning for the risk of thyroid cancer. This is because semaglutide, the active ingredient in Ozempic, has caused thyroid C-cell tumors in animals during studies [19]. It is unknown if Ozempic has the same effect in humans. Mounjaro has also been found to cause thyroid tumors in rats [23].

 

Hypoglycemia: Low blood sugar, especially when used with other diabetes medications. This is because both medications work by increasing insulin release and lowering blood sugar levels [20]. Symptoms can include dizziness, confusion, and fainting [20].

 

Long-Term Risks

While most side effects are short-term, some long-term risks have been identified:

 

Muscle loss: Ozempic has been associated with muscle loss [24].

 

Malnutrition and disordered eating: Mounjaro can significantly reduce appetite, potentially leading to malnutrition and disordered eating, especially when used without proper medical supervision [23].

 

Increased fatigue: Both medications may increase fatigue in some individuals [20].

 

Summary of Clinical Trial Findings

 

Clinical Trial | Population | Intervention | Primary Outcome | Key Findings

--------------|------------|--------------|-----------------|-------------

SUSTAIN-6 [1] | Adults with type 2 diabetes and high cardiovascular risk | Once-weekly subcutaneous semaglutide (Ozempic) vs. placebo | MACE (cardiovascular death, nonfatal MI, or nonfatal stroke) | Semaglutide reduced the risk of MACE by 26%

SELECT [3] | Adults who are overweight or obese and have established cardiovascular disease but without diabetes | Once-weekly subcutaneous semaglutide 2.4 mg vs. placebo | MACE (cardiovascular death, nonfatal MI, or nonfatal stroke) | Semaglutide reduced the risk of MACE by 20% and all-cause mortality by 19%

SUMMIT [8] | Adults with heart failure with preserved ejection fraction (HFpEF) and obesity | Tirzepatide (Mounjaro) vs. placebo | Combined risk of cardiovascular death and worsening heart failure events | Tirzepatide reduced the combined risk by 38%

 

Conclusion

Ozempic and Mounjaro have shown promising results in reducing cardiovascular risk, particularly in individuals with type 2 diabetes and established cardiovascular disease. While Mounjaro is not yet FDA-approved for this indication, emerging evidence suggests similar cardiovascular benefits. Although research directly linking these medications to increased lifespan is limited, their positive effects on weight management, metabolic health, and chronic disease prevention may contribute to longevity. However, being aware of these medications' potential risks and side effects is essential. Patients should consult with their healthcare providers to determine if Ozempic or Mounjaro is an appropriate treatment option.

 

It is important to acknowledge that the long-term effects of Ozempic and Mounjaro on lifespan and cardiovascular health require further investigation. More research is needed to fully understand these medications' potential benefits and risks, particularly in diverse populations and with longer follow-up periods.

 

References

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