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Does Ozempic lower cholesterol?

Although Ozempic has shown promise in lowering cholesterol, it is not as effective as statins and lifestyle changes
By | Oct. 10, 2024
A cholesterol lipid panel with a stethoscope and a hand holding a pen: Does Ozempic lower cholesterol?

Key takeaways

  • Ozempic is one of the glucagon-like peptide-1 receptor agonists that has been shown to not only lower blood sugar and assist with weight loss, but also lower cholesterol levels.

  • On top of lowering cholesterol, Ozempic has been associated with a reduction in cardiovascular event rate in some patients, meaning fewer heart attacks, strokes, and deaths from cardiovascular causes.

  • Although Ozempic does not lower cholesterol enough for this to be a primary use, it can be used in combination with other lipid-lowering drugs, like statins.

In this article:

American headlines are loaded with news on Ozempic (semaglutide), the Type 2 diabetes drug popularly used off-label for weight loss. Dig a little deeper into the information coming out on Ozempic, and you will find that clinical trials have found its use to be associated with lower cholesterol levels. More importantly, the benefits translate to fewer strokes, heart attacks, and deaths from cardiovascular causes. Those are profound findings, considering that cardiovascular disease is typically the most feared complication of diabetes. We’ll go into more detail about Ozempic’s cholesterol and cardiovascular benefits to prepare to talk to your healthcare provider about it.

The relationship between cholesterol and diabetes

Diabetes is associated with abnormal cholesterol levels—specifically, elevated triglycerides, reduced high-density lipoprotein cholesterol (HDL), and more small-dense low-density lipoprotein cholesterol (LDL). These abnormalities are all contributors to atherosclerosis, the accumulation of plaque along the inner walls of arteries.

Atherosclerosis as a result of these high cholesterol and Type 2 diabetes can lead to deadly cardiovascular events, which is why it is so important to control blood sugar and cholesterol levels in the setting of diabetes. Reducing heart attack and stroke risk is of the utmost priority.

Does Ozempic help lower cholesterol?

Studies comparing Ozempic with a placebo (an inactive pill) have shown Ozempic therapy to be linked to lower cholesterol. The reductions extend across the lipid panel to include increases in HDL (good cholesterol) and decreases in LDL (bad cholesterol) and triglycerides. 

A study on semaglutide (Ozempic) treatment for Type 2 diabetes found improvement in both cholesterol and high blood pressure. Similar findings were noted in a study on its use for weight management (an off-label use) in those who were overweight or had obesity.

The rate of atherosclerotic cardiovascular events, the more important clinical trial endpoint, has also been shown to be lower with Ozempic treatment. The details of these findings may differ depending on a patient’s specific health conditions. For example, a study published in the New England Journal of Medicine reported lower rates of heart attack, stroke, and cardiovascular death among those using semaglutide in the setting of Type 2 diabetes coupled with high cardiovascular risk.

Considering the evidence, it is no wonder that the Food and Drug Administration (FDA) has approved Ozempic for lowering the cardiovascular event rate in patients with Type 2 diabetes and cardiovascular disease, such as heart disease. The translation of that indication is that cardiologists, endocrinologists, and primary care doctors may prescribe Ozempic to a patient with diabetes and known atherosclerotic disease even if their blood sugar is already well controlled. Healthcare providers trying to choose between glucose-lowering medications for Type 2 diabetes may recommend Ozempic over other options based on the cardiovascular benefits.

How does Ozempic lower cholesterol?

The exact mechanisms by which Ozempic lowers cholesterol and cardiovascular risk are not fully clear. Ozempic is a glucagon-like peptide-1 receptor agonist (GLP-1 agonist). Its mechanism involves increasing insulin release after meals, which lowers blood sugar. It also inhibits glucagon release and slows gastrointestinal transit, which both reduce appetite.

Considering that Ozempic reduces appetite and food cravings and is associated with weight loss, it is not surprising that cholesterol goes down with its use. A study on mice found that GLP-1s like Ozempic may have an anti-inflammatory effect on atherosclerosis.

Wegovy may also lower cholesterol at similar doses to Ozempic since it contains the same active ingredient as Ozempic (semaglutide) but was specifically FDA approved for weight loss. On the other hand, Rybelsus, which is oral semaglutide, may not have identical results due to dosing differences. Rybelsus does not have an FDA indication for cardiovascular risk reduction.

RELATED: Wegovy vs. Ozempic 

The argument that cholesterol and cardiovascular event reduction is an effect of GLP-1 agonists is strengthened by studies that led the FDA to grant similar approval for cardiovascular event risk reduction to other GLP-1 medications. These include the injectable Type 2 diabetes treatments Trulicity (dulaglutide) and Victoza (liraglutide). However, Mounjaro (tirzepatide), a newer GLP-1 agonist for diabetes, does not yet have this indication from the FDA.

Considerations when taking Ozempic with high cholesterol

Before giving Ozempic too much credit for lowering cholesterol, it’s important to understand critical caveats. First, Ozempic use has not lowered cholesterol enough to effectively manage high cholesterol. Furthermore, treating high cholesterol is not an FDA-approved use of Ozempic. It is still only FDA approved to treat Type 2 diabetes and to lower the risk of cardiovascular events in adults with Type 2 diabetes and known heart disease. 

One of the hazards of severely elevated triglycerides is an uptick in pancreatitis attacks, a serious inflammatory condition of the pancreas. Pancreatitis also happens to be one of the serious side effects of Ozempic. The FDA warns about that risk on the drug label. Consequently, to avoid overlapping risk factors for pancreatitis, it may be best to reduce triglyceride levels below an extreme range by other means before starting Ozempic.

Ozempic does not stand alone for lipid lowering. Statins still play the foremost role in cholesterol and cardiovascular risk reduction. Healthcare providers commonly recommend combining a statin like Crestor (rosuvastatin) or Lipitor (atorvastatin) with Ozempic in the treatment of Type 2 diabetes and high cholesterol.

Statins are not only more effective for lowering cholesterol, but also they are available at a much lower price due to generic options being available. If price is a limiting factor to starting Ozempic, try using a coupon for Ozempic or the SingleCare discount card at your pharmacy.