Stopping weight loss injections could double the risk of heart attack, stroke or death for people with type 2 diabetes, a study has suggested.
The research focused on people with type 2 diabetes who had no established heart disease when the study began.
It found that heart health was better among those who remained on GLP-1 drugs than among those who came off them.
GLP-1 drugs are already thought to benefit the heart, with research indicating they may reduce inflammation and improve how blood vessels function.
Weight loss itself also tends to bring improvements in blood pressure, inflammation and cholesterol, all of which are good for the heart.
For the research, experts examined electronic medical records from more than 300 diabetes clinics across Italy.
The team, which included specialists in Italy and from Guy’s and St Thomas’ NHS Foundation Trust in London, identified more than 80,000 people with type 2 diabetes who were on GLP-1 drugs.
Those who carried on with treatment used a GLP-1 drug for nearly three years on average. People who stopped averaged just over one year of treatment.
Overall, the results suggested that the risk of a non-fatal heart attack, non-fatal stroke or death from any cause was about twice as high in people who stopped treatment as in those who continued.
The researchers said this worked out at about four strokes or heart attacks per 100 people per year among those who stopped, against two per 100 among those who carried on.
Risks among those who stopped appeared higher for people who were still obese.
Further analysis suggested stopping the drugs may affect the heart whether or not people regained weight afterwards, or saw their blood sugar and blood pressure rise.
Writing in the Lancet Regional Health – Europe journal, the researchers stressed the study was observational.
They noted it could be that people who stopped taking GLP-1 drugs were already in poorer health.
The reasons people stopped treatment were also not taken into account, the team said, though these may have included side-effects, cost, or illness such as frailty or cancer.
Dr Sonya Babu-Narayan, clinical director at the British Heart Foundation and consultant cardiologist, said: “These findings suggest that people with type 2 diabetes who stop taking GLP-1 medicines may face a higher risk of future heart attack, stroke or death than those who continue treatment.
“But there are important caveats to these findings, including that this was an observational study…
“More research is needed to understand the impact of stopping these medications and on the benefits and risks of being on them long-term.
“GLP-1 medicines have emerged as important heart medications. For those people who are recommended them by a doctor, it is important they are used in conjunction with heart healthy behaviours.
“These include eating a varied and balanced diet with plenty of protein and fibre and getting regular physical activity including strength exercises.”
Dr Faye Riley, research communications lead at Diabetes UK, said: “We know that GLP-1 medication can help protect against heart attacks and strokes.
“This study found that people with type 2 diabetes who stopped taking GLP-1s had a higher risk of heart problems compared to those who continued treatment.
“However, these findings should be interpreted with caution. This was an observational study, so we can’t tell whether stopping taking GLP-1s directly raised people’s risk of heart attack and stroke, or if those who discontinued treatment were already experiencing health problems.
“The findings reinforce the importance of supporting people to stay on treatments that work for them.
“Anyone with type 2 diabetes who is considering stopping treatment should speak to their healthcare team first.”
Juliet Bouverie, chief executive of the Stroke Association, said both types of diabetes, obesity and high blood pressure increase the risk of stroke.
She added: “Emerging research into GLP-1s is encouraging and adds to growing evidence of their potential benefits beyond blood sugar control and weight management.
“Whilst further research is needed to understand their role in stroke prevention, these findings highlight the potential for new approaches to reducing stroke risk.
“At the same time, tackling existing risk factors of stroke – including poor diet, drinking too much alcohol, smoking and not taking regular exercise – remains essential to reduce the growing burden of stroke.”
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