Boxes of Ozempic and Wegovy from Novo Nordisk can be seen in a pharmacy.
Hollie Adams | Reuters
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GLP-1 is available virtually everywhere—about one in eight adults in the U.S. takes one.
However, stopping these medications may come at a cost.
That’s according to a new study from Washington University School of Medicine published Wednesday in BMJ Medicine.
The research found that even short gaps in treatment with a GLP-1 can increase the risk Heart attack, stroke and death in patients with type 2 diabetes, and the effects may not be completely reversible. Using electronic health records, researchers tracked more than 333,000 adults with diabetes over a three-year period, and the lion’s share of them had diabetes Novo Nordisk‘s diabetes injection Ozempic.
Here are the key data points:
- In patients who received GLP-1 for three years, cardiovascular risk fell by 18%.
- Stopping GLP-1 for just six months eliminated much of this protection and increased the risk by 4% compared to continued use.
- A two-year break from treatment increased this risk to 22% compared to long-term use.
GLP-1 does “much, much more than just weight loss,” said study author Dr. Ziyad Al-Aly, an epidemiologist from WashU Medicine, in an interview. “They reduce all those back problems, lower cholesterol, lower blood pressure, reduce insulin resistance, reduce inflammation and provide real cardiovascular protection.”
“When people stop GLP-1, this cardiovascular protection ceases to exist, and also there is some asymmetry here,” he added. “It takes years to build cardiovascular protection and half as much to reverse it.”
Al-Aly called it a “metabolic whiplash” where any improvements “go in the wrong direction” once treatment ends.
The results are not a complete surprise.
GLP-1 are 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 reduce the risk of major cardiovascular events in adults with existing heart disease and obesity.
But the new study provides some of the first large-scale evidence of what happens to patients’ hearts when they stop these medications, particularly in diabetics.
The research also underscores an ongoing problem — high dropout rates due to difficulty accessing them and side effects such as nausea and vomiting — that the health system has not yet fully addressed. According to several studies, discontinuation rates for GLP-1 range from 36 to 81%.
Al-Aly said providers and patients considering GLP-1 therapy should understand that patients need to stay on treatment “for the long term,” not just a few months or even years.
He also noted the need to address the root causes of abortion, such as proactively controlling side effects. The access problem is likely to improve in the US, especially as major players want Eli Lilly are continuing efforts to increase obesity drug coverage among employers, and the federal Medicare program is preparing to cover weight-loss treatments for the first time.
Maintaining treatment for patients “should not be an afterthought,” he said. “People need to realize that quitting comes at a cost.”
Drugmakers are also working to solve the discontinuation problem, with hopes of developing next-generation obesity and diabetes treatments that offer comparable effectiveness with fewer unwanted side effects.
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