Autoimmune diseases raise the risk of heart disease, stroke, and blood clots. For those also living with obesity, these risks climb even higher.
“The key takeaway is that the potential benefits of GLP-1 therapy may extend beyond the number on the scale,” says study author Amy Sheer, MD, MPH, an associate professor of internal medicine at the University of Florida College of Medicine in Gainesville. “For someone already taking a GLP-1 medication, this reinforces the idea that obesity treatment is not cosmetic — it’s a chronic disease treatment and risk-reduction medication.”
GLP-1s Users Had Lower Rates of Blood Clots, ER Visits, and Death
The study analyzed health records from more than 26,000 adults with obesity and at least one autoimmune disease, such as rheumatoid arthritis, psoriatic arthritis, type 1 diabetes, vitiligo, and celiac disease.
Researchers compared people prescribed GLP-1 medications with similar adults not taking the drugs. They tracked cardiovascular events, blood clots, healthcare utilization, and death.
Compared with nonusers, adults taking GLP-1s had a:
- 17 percent lower risk of venous thromboembolism, or blood clots in the veins
- 31 percent lower risk of pulmonary embolism, a potentially life-threatening clot that travels to the lungs
- 21 percent lower risk of going to the emergency department
- 44 percent lower risk of all-cause mortality (death from any cause)
Researchers also observed lower stroke rates among GLP-1 users, although this difference didn’t reach statistical significance.
Experts say the 44 percent reduction in all-cause mortality was particularly striking.
“The surprise here is the magnitude of the effect of taking these drugs,” says Nasser Lakkis, MD, a cardiologist and chair of the internal medicine department at the University of South Alabama in Mobile.
“Many of the drugs we use in cardiovascular medicine have a much lower impact, so if this is validated, it’s very clinically significant,” says Dr. Lakkis, who was not involved in the study.
How Autoimmune Diseases Can Impact the Heart
“Obesity adds another layer of low-grade inflammation from adipose tissue,” or body fat, says Deepu Sudhakaran, MD, a bariatric surgeon who specializes in metabolic health at Zae Weight Wellness in Chesterfield, Missouri. “Inflammation is likely one of the central links connecting obesity, autoimmune disease, and cardiovascular risk.”
Dr. Sheer says the link between autoimmune disease and cardiovascular risk is likely driven by multiple overlapping factors, including:
Because of these risks, people living with both obesity and autoimmune disease have a significantly higher risk of cardiovascular complications.
“The main message is that patients with obesity and autoimmune disease are a high-risk and historically understudied group,” says Sheer. “They should not be left out of the conversation about modern obesity treatment.”
How Might GLP-1 Medications Help?
GLP-1 medications promote weight loss by slowing stomach emptying, increasing feelings of fullness, and helping regulate blood sugar levels.
“If you have an autoimmune disease, specifically a rheumatologic disease affecting the joints, muscles, bones, and connective tissues, then your mobility can decrease significantly,” Lakkis explains. “That often starts a cascade that can lead to further obesity.”
“Weight loss helps reduce metabolic and inflammatory burden, and improved blood sugar control is important, especially in patients with diabetes,” Dr. Sudhakaran says. “But GLP-1 medications also appear to have anti-inflammatory, vascular, and possibly antithrombotic [blood clot-reducing] effects. I would not view them simply as weight-loss drugs. They may be broader metabolic and inflammatory disease-modifying therapies.”
The Study Has Some Limitations
While the findings are promising, experts caution they don’t prove GLP-1 medications directly caused the reductions in cardiovascular risk.
“The biggest limitation is that the study cannot prove cause and effect,” Sudhakaran says. “GLP-1 users may differ from nonusers in ways that are not fully captured, such as socioeconomic status, health behaviors, disease severity, medication adherence, or access to care.”
Lakkis notes that the study also did not report how much weight participants lost, making it difficult to determine how much of the benefit may have been driven by weight reduction itself.
“If you lose weight, then you’re more mobile, you have less inflammation, and you’re at a lower risk of venous thrombosis,” he says. “That mechanism may explain the robust mortality reduction that we’re seeing.”
The study also included a variety of autoimmune disorders, which “may hide important differences between conditions,” Sudhakaran says. “Dose, duration, adherence, and changes in other medications over time are also important unanswered issues.”
Researchers say randomized clinical trials will be needed to confirm the findings and better understand how GLP-1 medications may affect cardiovascular risk in people with autoimmune diseases.
“I would frame these findings as hypothesis-generating and clinically important, but not definitive proof that GLP-1 therapy directly caused the reductions we observed,” Sheer says.
GLP-1s Aren’t a One-Size-Fits-All Solution
Experts stress that the results should not be interpreted as proof that everyone with obesity and an autoimmune disease should take a GLP-1 medication.
”Patients should not assume the GLP-1 medication alone eliminates risk. It should be part of a comprehensive medical plan,” Sudhakaran says.
Instead, Sheer underscores the importance of discussing heart disease risk reduction — including weight management, physical activity, blood pressure control, and appropriate medication options — with a healthcare provider.
“Addressing obesity is one of the ways we can improve long-term health outcomes in patients with autoimmune disease,” Sheer says.
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