GLP-1s Cut ER Visits, CVD Risk in Patients With Obesity

In patients with both obesity and an autoimmune disease, glucagon-like peptide-1 (GLP-1) receptor agonists demonstrated lower rates of emergency visits and cardiac event instances, according to a release from the American Heart Association.¹

“This is a high-risk population, and historically, we’ve had limited data to guide treatment decisions,” Amy Sheer, MD, MPH, associate professor of medicine and director of the Obesity Medicine Fellowship program at the University of Florida, said in a news release. “In this real-world analysis, we found a consistent signal toward fewer serious complications, including blood clots and lower mortality, among patients treated with GLP-1.”

The analysis, which reviewed electronic health record data for more than 26,000 adults in the OneFlorida+ network, found that patients taking these medications experienced a 17% lower risk of venous thromboembolism and a 31% lower risk of pulmonary embolism. Perhaps most striking was a 44% reduction in all-cause mortality, a finding that experts say suggests the benefits of these agents extend far beyond simple glycemic control and weight loss.¹

For pharmacists, these findings underscore the expanding clinical utility of GLP-1 receptor agonists in managing complex, high-risk populations where systemic inflammation and metabolic dysfunction overlap.^1,2

READ MORE: GLP-1s Could Replace the Need for Knee Replacement Surgery

The mechanism behind these benefits involves mimicking the natural GLP-1 hormone released in the gastrointestinal tract, which triggers insulin release, increases satiety, and slows gastric emptying. Beyond weight management, these physiological effects have been linked to improvements in a wide array of comorbid conditions, including heart failure with preserved ejection fraction, obstructive sleep apnea, and metabolic dysfunction-associated steatohepatitis.^2,3

Pharmacists at the Forefront of GLP-1 Management

However, the real-world application of these therapies presents a unique set of challenges that place pharmacists at the center of the care team.²

Pharmacists are increasingly tasked with navigating what researchers call “metabolic whiplash,” which occurs when these medications are interrupted. A study of over 333,000 veterans found that stopping GLP-1 therapy for as little as 6 months was tied to a significant jump in the risk of major cardiovascular events, including an increase of up to 22% for heart attack and stroke after 2 years off the medication, according to Washington University Medicine.⁴

Although weight regain is a visible consequence of stopping therapy, the “metabolic reversal,” including a resurgence in blood pressure, cholesterol, and systemic inflammation, is not—making continuous treatment essential for sustained cardiovascular protection.

The Persistent Hurdles Regarding GLP-1 Use

Pharmacists must also remain vigilant regarding emerging safety signals.

Recent real-world evidence suggests a potential association between GLP-1 agonists and an increased risk of certain new autoimmune conditions, such as ulcerative colitis, rheumatoid arthritis, and psoriasis, when compared with dipeptidyl peptidase-4 inhibitors.⁵

Although the overall incidence remains low, this paradox highlights the complexity of how these agents modulate the immune system and gut microbiota, necessitating careful monitoring by clinical pharmacists during therapy titration.

Managing the common adverse effect profile remains a critical pillar of the pharmacist's role in the patient care process. Gastrointestinal issues, including nausea, vomiting, and diarrhea, are the most frequent barriers to adherence.^2,3

Pharmacists can mitigate these by recommending slow dose escalations and dietary modifications, such as eating smaller, more frequent meals and avoiding high-fat or greasy foods. Furthermore, pharmacists must counsel patients on rarer but more serious risks, including pancreatitis, gastroparesis, and the potential for the sagging and wrinkling of skin caused by rapid fat loss—otherwise known as “Ozempic face.”

Operational hurdles also persist as pharmacists face significant financial and supply chain pressures. Shortages of semaglutide and tirzepatide have historically limited treatment continuity, and some community pharmacies report losing money on every GLP-1 prescription dispensed due to low reimbursement rates.²

Additionally, the lack of Medicare coverage for anti-obesity medications remains a significant barrier to health equity, though recent proposals suggest an expansion of coverage for patients with specific comorbid conditions like cardiovascular disease (CVD).

As GLP-1 therapies continue to redefine chronic disease management, the pharmacist's expertise in medication therapy management is vital. By addressing adherence, managing adverse effects, and advocating for patient access, pharmacists ensure that the revolutionary benefits of these medications, from reduced emergency department visits to lower mortality, are fully realized in clinical practice.²

“I am excited about the combination of medications for these diseases—pairing medicines with known benefits to treat the autoimmune disease with a GLP-1,” concluded Sheer.¹ “For people who are overweight or living with obesity and an autoimmune disease, this study offers a hopeful signal that medications already in use today may be beneficial in reducing their risk of CVD.”

READ MORE: Obesity Management Resource Center

REFERENCES

1. GLP-1-based meds linked to fewer heart events in adults with obesity, autoimmune disease. News Release. American Heart Association. June 6, 2026. Accessed June 8, 2026. https://www.eurekalert.org/news-releases/1130405

2. Lingow S, Carris N, Clements J, et al. The pharmacist’s role in the use of incretin‐based therapies for weight management: an opinion of the Endocrine and Metabolism Practice and Research Network of the American College of Clinical Pharmacy. JACCP. 2025;8(10):1078-1093. https://doi.org/10.1002/jac5.70111

3. Catanese L. GLP-1 diabetes and weight-loss drug side effects: “Ozempic face” and more. Harvard Health Publishing. February 5, 2024. Accessed June 8, 2026. https://www.health.harvard.edu/healthy-aging-and-longevity/glp-1-diabetes-and-weight-loss-drug-side-effects-ozempic-face-and-more

4. Ballard S. Stopping GLP-1 drugs can quickly erase cardiovascular benefits. WashU Medicine. March 18, 2026. Accessed June 8, 2026. https://medicine.washu.edu/news/stopping-glp-1-drugs-can-quickly-erase-cardiovascular-benefits/

5. Lee YJ, Fang YW, Chen MT, et al. Association between autoimmune diseases and glucagon-like peptide-1 receptor agonists: a real-world evidence study. J Autoimmun. 2025;155:103453. https://doi.org/10.1016/j.jaut.2025.103453