Among the various classes of medications in the U.S., GLP-1s have become rather hot. None have created more buzz in the medical community and with patients than in Los Angeles. From Westwood to Beverly Hills to Santa Monica, patients are approaching their doctors about these medications and how they can help with not just diabetes, weight loss but, more recently, long-term improvement of cardiovascular health.

When patients with heart disease, as well as those with cardiac surgery in their near future or those in recovery, want to know more about these medications, the conversation becomes more complex. There are real benefits of these medications for the heart, but there are surgical considerations that each and every one of these patients ought to know.

As the cardiac surgeon at Ronald Reagan UCLA Medical Center in Westwood, Dr. Maria Tehrani sees numerous patients from Los Angeles who want to know how these medications will integrate into their cardiac care plan.

What Are GLP-1 Medications, Anyway?

GLP-1 is short for glucagon-like peptide-1. As a naturally-occurring hormone in the body, it plays a role in the regulation of both blood sugar and appetite. Drugs that are referred to as GLP-1 receptor agonists bind to the receptor of this hormone and mimic its hormonal activity in several ways: promoting the secretion of insulin in cases of elevated blood sugar, decreased gastric emptying, a muted sensation of appetite, and a decrease of glucagon.

Ozempic and Wegovy (semaglutide), Mounjaro and Zepbound (tirzepatide), Trulicity (dulaglutide), Victoza and Saxenda (liraglutide) are some of the more well-known medications in this class. Because they are prescribed for type 2 diabetes or chronic weight management, and for the reduction of cardiovascular risk in certain patients, they have received various approvals from the FDA.

Why These Medications Are on Cardiac Surgeons’ Radar

For a long time, clincians relied on procedures and indirect management to tackle the risks of heart disease in patients with obesity and type 2 diabetes. However, now that cardiovascular benefits can be found in GLD-1 medications — which have been clinically proven to treat diabetes and obesity in peripheral vascular disease, GLD-1 medications have proven to reduce major adverse cardiovascular events, control HbA1c levels, reduce inflammatory markers of atherosclerosis, positively impact cholesterol and triglycerides, and even assist patients in achieving desired weight goals.

For many LA patients with coronary artery disease, prior bypass surgery, valve disease, or heart failure, these medications can be a meaningful part of long-term care alongside statins, blood pressure control, and lifestyle changes.

Cardiologists and Anesthesia are Concerned About Stomach Delaying

There is only one clinical observation of extreme concern to both a cardiac surgeon and an anesthesiologist, and it has to do with the delayed gastric emptying of GLP-1 medications. Since GLP-1 medications slow the rate of gastric emptying, patients can end up having food or drink in their stomachs. This can occur even after an adequate fasting period before surgery.

This is important because of the huge risks involved in general anesthesia. The muscles which control a patient’s own airway become completely relaxed and stomach contents can then flow into the lungs — a serious condition called pulmonary aspiration. This is rare, although it can be life-threatening.

Elective cardiac surgeries have prompted changes in guidance from many anesthesiology organizations. Recommendations differ from patient to patient. However, here are a few things that most organizations suggest:

– Holding the medication prior to surgery. For weekly injections, they may be held for about a week prior to surgery. Daily injections may be held the day of surgery. Timing will be answered by your surgeon and anesthesiologist.

– Lengthening the fasting period for food, especially solid food.

– A clear liquid diet, which may be the case for 24 hours prior to surgery.

– Ultrasound at the bedside to determine the contents of the stomach prior to the start of surgery for patients in a surgical case that puts them more at risk.

– Changing the anesthesia as needed to minimize the risk of aspiration.

Remember, you should never stop or modify your GLP-1 medication without consulting your medical care team. Inform your cardiac surgeon and anesthesiologist that you take it, and then follow their instructions.

If you have cardiac surgery scheduled, what should you tell your doctor?

If you’ve been scheduled for any heart surgery (CABG, valve repair or replacement, aortic aneurysm repair or replacement, minimally invasive heart surgery, or an evaluation for transplantation), it is essential to tell your entire surgical team which GLP-1 medication you take as well as the dose and how long you’ve been on it, when was the last time you took it, if you have had nausea, vomiting, or reflux, and what other medications and supplements you take.

Surgical patients often think reports and studies will detail that GLP-1 medications are common, so the surgical team will be informed on the protocol. The best approach is always to inform your surgical team.

Restarting GLP-1 Therapy after Cardiac Surgery

Your specific situation plays a role in determining when a GLP-1 medication is restarted after cardiac surgery. Some considerations include how well you are eating and drinking, the presence and severity of postoperative nausea or gastrointestinal symptoms, the control of your blood sugar levels, the status of your recovery, and any new medications you have been prescribed.

Patients typically are not restarted on GLP-1 medications right after surgery. Recovery from surgery includes many changes such as alterations in appetite and diet (often to smaller portion meals). Healing should also be a priority and could be impacted by these medications. The safe administration of GLP-1 therapies is typically acceptable in the weeks after surgery as long as you have resumed normal eating.

Side Effects

Although patients with cardiac disease tolerate GLP-1 therapies well, the side effects of the medications can include nausea and vomiting and constipation with dose escalations; heart failure and diuretic-related dehydration; hypoglycemia with the mixture of insulin or sulfonylureas; gallstones; rare, but rapid onset, pancreatitis; and loss of fat with concomitant loss of muscle leading to a negative impact on cardiac rehab.

If any of these symptoms are present, especially abdominal pain, vomiting, or any signs of dehydration, seek out medical care.

Special Considerations for LA Patients

Some practical tips for Los Angeles patients using or planning to use GLP-1 medications.

– Wellness and weight-loss clinics. Los Angeles has many wellness clinics and online sites promoting their own compounded versions of these medications. There are big variations in quality. Your birth cardiac team needs to know exactly what you are taking.

– Active lifestyles. Using GLP-1s for weight loss can mean losing lean mass. During cardiac rehabilitation, you should increase your protein intake and strength training.

– Sun and dehydration. The Southern California sun can lead to dangerously increased dehydration because of an increased appetite and fluid intake. This can be worsened for people taking diuretics or those with heart failure.

– Concurrent medications. Dosage adjustments are common and should be monitored for patients taking blood thinners, statins, beta blockers, or anti-arrhythmics. Ensure that your full medication list is reviewed regularly.

For GLP-1 medications to be used most effectively for cardiac surgery patients, patients need to adhere to all aspects of cardiac care, including controlling blood pressure, managing cholesterol, exercising and eating a healthy diet, sleeping, and following up on time.

For patients undergoing cardiac surgery, being honest with your surgical team about every dose and every change to your GLP-1 and every corresponding side effect is vital. These medications require a coordinated planning as part of the cardiac care.

Schedule a Consultation in Westwood

Dr. Maria Tehrani offers expert evaluation and treatment across Los Angeles for patients who have been advised cardiac surgery and take GLP-1 medications or other patients with heart disease wanting advice on how Ozempic, Wegovy, Mounjaro, or other similar medications should be integrated into their therapeutic treatment plans.