Semaglutide (Ozempic, Wegovy) and Heart Palpitations

Every age has its own special diseases. Before antibiotics' invention, a bacterial infection was often lethal. In our modern world, bacteria are still dangerous, but other health conditions claim more lives than before. In particular, a new disease is becoming more and more a burden for our society: diabetes mellitus type 2. In this article, we will take a close look at semaglutide, a drug used in the treatment of diabetes. We will explore whether it can cause heart palpitations and its potential benefits for cardiovascular disease.
Jakub Gwiazdecki

Jakub Gwiazdecki

Fifth year medical student at the Medical Faculty of Comenius University in Bratislava.

A blue image with text saying "Can Semaglutide Cause Heart Palpitations?"

Can semaglutide cause heart palpitations?

No, according to the available evidence-based studies, semaglutide does not cause heart palpitations.

Safety studies of that drug showed no electrical cycle changes, which are normally the primary cause of heart palpitations. No ECG changes were found at normal and high dosages of semaglutide [1].

In fact, a recent study suggests that semaglutide may decrease the risk of heart palpitations. A study by Dao-Gen Yin et al. has found that this diabetes medication can reduce the risk of atrial fibrillation by nearly a third [2]. Atrial fibrillation is one of the conditions that causes symptoms of heart palpitations.

However, semaglutide is a very recent drug (it came out in 2017), and due to this, little is known about its long term use. The studies and statements do not exclude the possibility of heart palpitations occurring with long-term use.

What is Semaglutide?

Semaglutide is a glucagon-like peptide-1 (GLP-1) receptor agonist. This is a type of medication that mimics the action of GLP-1, a naturally occurring hormone in the body. Semaglutide is used in the treatment of type 2 diabetes mellitus (DM2). However, recently, it has started to be used in the treatment of obesity [3, 4, 5, 6].

Semaglutide is an active substance in the drugs Ozempic, Wegovy, and Rybelsus. While Rybelsus comes in the form of a tablet, Ozempic and Wegovy are subcutaneous injections administered once a week. The oral form of semaglutide offers a convenient alternative to injectable diabetes medications [3, 4, 5, 7].

Although Semaglutide was developed to treat DM2, it shows promising potential in other treatments. The list of suggested diseases that could be managed with semaglutide includes type 1 diabetes, non-alcoholic fatty liver disease, non-alcoholic steatohepatitis, kidney disease, Alzheimer's disease, and pulmonary diseases [6].

How does semaglutide work?

Semaglutide is a glucagon-like peptide-1 (GLP-1) analogue [6]. It works by mimicking the functions of the natural hormone GLP-1 in the body.

One of the primary effects of semaglutide is the induction of weight loss. It regulates lipid metabolism and decreases fat accumulation as well as lipids found in the blood [8]. The regulation is supported by the decreases in appetite and lower fat absorption, as well as decreased lipogeneses in the liver and the increase in insulin sensitivity of the cells.

Another property of semaglutide is its anti-inflammatory effect. In a study of acute lung injury in rats, Zeyu Jiang et al. showed that cases of pretreated semaglutide were found to have smaller inflammatory reactions. It was measured by a reduced production of the inflammatory markers TNF-α and IL-6 [9].

The anti-inflammatory factor also has a positive effect on the kidneys. It protects against acute kidney injury [10].

Additionally, semaglutide has been shown to protect against Alzheimer's disease. Protection from this neurodegenerative disease is achieved by enhancing autophagy and inhibiting apoptosis [11]. It also has potential benefits for chronic liver disease-induced skeletal muscle atrophy by stimulating GLP-1R in myocytes [12].

Furthermore, in mouse models that are prone to atherosclerosis, semaglutide has been found to reduce vessel remodeling following vascular injury [13]. This can be an effect of the reduction in lipid levels as well as lower inflammatory levels. Both of those factors contribute to the endothelial imbalance, which is a main contributor to atherosclerosis.

Semaglutide allows for modulating the calory intake. It has been shown to reduce food intake and slow gastric emptying [14]. The cause of this reduced food intake is the feeling of fullness and lower hunger levels this drug evokes in the brain.

How does semaglutide influence the heart?

Semaglutide has been found to have several beneficial effects on the heart. The primary impact on the heart is caused directly by weight loss. With a smaller mass, the workload of the myocardium declines, stressing the heart to a lesser extent. Additionally, lower blood pressure as well as lipid and sugar levels in the blood follow the loss in weight, lowering the cardiovascular risk factors. This GLP-1 analogue reduces the risk of heart attack, stroke, or death in type 2 diabetes and heart disease [15]

Jakub Gwiazdecki

Jakub Gwiazdecki

Jakub is in his fifth year as a medical student at Comenius University in Bratislava, Slovakia. He has special interested in cardiology and in patient-centered medicine. His love for heart health isn't just book-smarts; he wants to know how it works, what it means for our feelings, and how key it is for health and happiness. Jakub thinks real good health care comes from always putting the patient at the centre, treating each person as a whole.