The American College of Cardiology has issued new guidelines recommending weight management medications as first-line treatments for eligible patients. This contrasts with prior guidelines that required trying lifestyle changes before pharmacotherapy.

The guidelines focuse on two weight management medications that have shown superior effectiveness: semaglutide (a GLP-1 receptor agonist) and tirzepatide (a GLP-1/GIP receptor agonist). These medications target hormone receptors that control appetite and blood sugar levels. Clinical evidence demonstrates these drugs reduce major cardiovascular events — including heart attacks, strokes and cardiovascular death — particularly in individuals with type 2 diabetes and elevated cardiovascular risk.

“Patients should not be required to ‘try and fail’ lifestyle changes prior to initiating pharmacotherapy; nonetheless, lifestyle interventions should always be offered in conjunction with obesity medications,” said Olivia Gilbert, MD, MSc, chair of the guidance and a cardiologist at Atrium Health Wake Forest Baptist Medical Center.

This recommendation signals a more proactive role for pharmacotherapy in cardiovascular care. Modern obesity medications prove more effective than lifestyle interventions alone at achieving weight loss and reducing overall cardiovascular disease risk, while presenting fewer risks than surgical procedures, according to the guidance.

Clinical trials indicate tirzepatide produces slightly greater weight loss compared to semaglutide, though insurance coverage, availability and cost typically determine which weight management medications physicians prescribe.

Obesity management guidance

In a separate development, the College released a scientific statement addressing obesity management specifically for heart failure patients. This guidance focuses on individuals with heart failure with preserved ejection fraction, a condition where the heart pumps normally but fills improperly.

The guideline emphasizes team-based care approaches, person-first language and addressing weight stigma in clinical settings. However, insurance coverage remains a major barrier for patients seeking these therapies.

Weight management medications require careful monitoring during initial dose escalation phases, which occur every four weeks. The guideline stresses coordinated care to assess risk factors, identify related health conditions, and customize treatment strategies for individual patients.