University Hospitals Preventive Cardiologist Authors Primer on Muscle Effects of GLP-1s

Innovations in Cardiovascular Medicine & Surgery | December 2024

Ian Neeland, MD, FAHA, FACC

Ian Neeland, MD, FAHA, FACC, Director of the Center for Integrated and Novel Approaches in Vascular-Metabolic Disease (CINEMA) at University Hospitals Harrington Heart & Vascular Institute, has joined with colleagues to produce guidance on one of the most important issues surrounding the wildly popular weight loss medications known as GLP-1s.

Writing in the prestigious journal Circulation, the trio of experts explores whether the muscle-related changes associated with GLP-1s are adverse effects on muscle health and function or are instead a physiological response to weight loss with minimal effect on muscle health and function. A third option explored is whether GLP-1s might lead to improved muscle health and function after treatment.

After carefully reviewing the existing data, the team concludes that skeletal muscle changes with GLP-1s appear to be adaptive. Changes in muscle volume with GLP-1s appear commensurate with what is expected given aging, disease status, and weight loss achieved. In addition, the improvement in insulin sensitivity and muscle fat infiltration seen with these medications likely contributes to an adaptive process with improved muscle quality, lowering the probability for loss in strength and function.

That said, Dr. Neeland and colleagues advise that providers prescribing these drugs consider factors such as older age and pre-frailty when selecting appropriate candidates for GLP-1s, given the risk of sarcopenia. This may soon be addressed by the pharmacologic treatments to maintain or improve muscle mass designed in combination with GLP-1–based therapies currently under development. Further, the team calls for more objective and comprehensive ways of assessing muscle health in patients taking these drugs, including accurate and meaningful assessments of muscle quantity, composition, function, mobility, and strength.

“This is important for the substantial numbers of patients who will likely be taking these medications well into the future,” they write.

Contributing Expert:
Ian Neeland, MD, FAHA, FACC
Director, Center for Integrated and Novel Approaches in Vascular-Metabolic Disease
University Hospitals Harrington Heart & Vascular Institute
Associate Professor
Case Western Reserve University School of Medicine