104: GLP-1s: More Than Just a Weight Loss Drug—How They're Transforming Cardiovascular Care with Dr. Simin Lee

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Heart disease is the leading cause of death for women, driven by the growing obesity epidemic and complex cardiometabolic issues that often slip through the cracks between primary care and specialists. The simple truth? Many women aren’t receiving the support they need to safeguard their heart health.

Enter Dr. Simin Lee, a Harvard-trained cardiologist and behavioral scientist who is revolutionizing women’s cardiovascular care. Dr. Lee founded Systole Health, a first-of-its-kind virtual clinic dedicated to women’s heart health. By combining expert medical care with the power of community, Systole Health empowers women with the knowledge, support, and personalized care plans they need to take charge of their health and thrive.

In this post, we’ll explore insights from Dr. Lee on the game-changing potential of GLP-1 medications in treating cardiometabolic health, why testing for lipoprotein(a) is essential, and how menopause-related hormonal shifts can increase heart risks. Most importantly, we’ll dive into the steps women can take to protect their hearts and bridge the gaps in traditional care.

The Cardiometabolic Benefits of GLP-1 Medications

GLP-1 medications are gaining attention for more than just their ability to support weight loss. Their impact on heart health, cholesterol, and inflammation is reshaping the way we think about treating cardiometabolic diseases. Let’s dive into three key areas where these medications are making a difference:

1. Lowering Blood Pressure

GLP-1 medications help reduce blood pressure through several fascinating mechanisms:

• Improved Blood Vessel Health: They act on the inner lining of blood vessels (the endothelium), helping the vessels relax and become more elastic. This reduces the rigidity that can drive high blood pressure.
• Natural Blood Pressure Regulation: These drugs stimulate the release of atrial natriuretic peptide (ANP), a hormone that prompts the kidneys to flush out excess salt and fluid, naturally lowering blood pressure.
• Weight-Related Effects: Reducing body weight relieves pressure on blood vessels, contributing to lower blood pressure.

2. Improving Cholesterol Levels

In clinical trials, GLP-1 medications have shown significant benefits in improving cholesterol profiles:

• LDL (Bad Cholesterol): Levels decrease by around 5%, reducing the risk of plaque buildup in blood vessels.
• HDL (Good Cholesterol): Levels increase by about 5%, helping combat inflammation and clearing LDL from circulation.
• Triglycerides: These fatty acids drop by an impressive 30%, further lowering heart disease risks.

3. Reducing Inflammation

Obesity and heart disease are deeply linked to inflammation, and GLP-1 medications are proving to be powerful anti-inflammatory agents:

• C-Reactive Protein (CRP): A marker of inflammation measured in blood tests, CRP decreases by 35-40% in patients using these medications.
• Heart Health Impact: By reducing inflammation, these drugs help stabilize cholesterol plaques in blood vessels, lowering the risk of heart attacks and strokes.

These multifaceted benefits explain why GLP-1 medications are delivering life-changing outcomes for many patients, including fewer heart attacks, strokes, and cardiovascular-related deaths. And as research continues, we’re only beginning to uncover their full potential.

Understanding LP(a) and Its Role in Heart Health

One of the more overlooked tests when it comes to heart health is LP(a), or lipoprotein(a). While many of us are familiar with routine cholesterol panels, including measurements like LDL (bad cholesterol) and HDL (good cholesterol), LP(a) is a cholesterol subtype that behaves quite differently and can have serious implications for your cardiovascular health.

What is LP(a) and Why Is It Important?

LP(a) is a type of cholesterol that structurally resembles LDL cholesterol but acts in a much more aggressive way. Like LDL, it can infiltrate the walls of your arteries and form blockages. However, LP(a) is known to cause blockages more rapidly and is more prone to triggering clot formation, which can contribute to heart attacks and strokes. The key difference between LP(a) and LDL is that while LDL levels are heavily influenced by lifestyle factors such as diet and exercise, LP(a) is almost entirely determined by genetics.

This means that no matter how well you eat or how active your lifestyle, elevated LP(a) levels can still pose a significant risk to your cardiovascular health.

Why You Should Be Tested for LP(a)

One in five adults have elevated LP(a) levels, but the majority don’t even know it. Routine cholesterol panels don’t include testing for LP(a), which means many people may be at risk without realizing it. In fact, studies have shown that less than 1% of patients who have already experienced a heart attack or stroke are tested for LP(a), and those who are found to have high levels are rarely referred to a specialist for further evaluation.

Given the potential for LP(a) to cause serious cardiovascular issues, it’s critical that people discuss this test with their doctors. A simple blood test can be done alongside your routine cholesterol checks, and knowing your LP(a) levels can help determine the best course of action to reduce heart disease risk.

The Impact of Menopause on LP(a) Levels

An interesting area of ongoing research is how LP(a) levels fluctuate during a woman’s life, particularly during the perimenopausal and menopausal transition. Studies have shown that LP(a) levels tend to rise during this period, making it an important time for women to pay attention to their cardiovascular health. However, the relationship between LP(a) levels and heart disease risk during menopause is still being explored, and while high levels are considered risky, we don’t yet know how much higher levels are considered dangerous in comparison to lower levels.

What Can You Do?

If you find out you have elevated LP(a), don't panic! While your genetics play a significant role in these levels, there are still steps you can take to manage your overall cardiovascular health. Work with your healthcare provider to monitor and manage other cholesterol levels, such as LDL, and explore available treatment options to help lower your risk.

Don’t forget: Knowledge is power. Don’t hesitate to bring up LP(a) testing at your next doctor’s appointment, and make 2025 a year dedicated to proactive health and less cardiovascular risk.

Understanding Cardiometabolic Changes During Menopause

One of the most important things for women to understand during the menopausal transition is how their cardiovascular and metabolic health is affected. Estrogen, which plays a protective role in maintaining heart health, begins to decline during perimenopause. Estrogen helps relax blood vessels, regulate cholesterol levels, and improve insulin sensitivity. As estrogen levels drop, women may experience increased blood pressure, higher cholesterol, and the onset of insulin resistance.

Additionally, many women notice a shift in body composition—fat begins to accumulate around the midsection, often referred to as the "menopause belly." This can be attributed to changes in metabolism as estrogen levels decline. If women don’t adjust their diet and exercise habits accordingly, they may experience weight gain. The increase in body fat, especially around the abdomen, further contributes to cardiovascular risks, including heart disease.

Navigating Hormone Replacement Therapy (HRT)

For women struggling with symptoms like hot flashes, brain fog, and sleep disruption, hormone replacement therapy (HRT) might be an option. HRT, which typically involves estrogen and sometimes progesterone, can help alleviate these symptoms and improve quality of life. However, its use is not without risk, especially for women who are older or more distanced from menopause.

The Women's Health Initiative (WHI) study raised concerns about the potential risks of HRT, including an increased risk of heart attacks, strokes, and blood clots. However, subsequent research has shown that the risk is nuanced—HRT can be more beneficial for women who are closer to the onset of menopause and at a lower risk for cardiovascular events. It's crucial to have a personalized, risk-based discussion with a healthcare provider to weigh the benefits and risks of HRT, particularly in younger, recently menopausal women.

The Importance of Early Conversations

One of the key takeaways is that women should not wait until after menopause to address these health concerns. It's never too early to start having conversations about heart health, hormone therapy, and overall wellness with healthcare providers. Many women mistakenly believe that these conversations should only begin once they haven't had a period for a year, but health professionals recommend starting in the mid-thirties or even earlier.

By proactively educating themselves and engaging in discussions about their health, women can make more informed decisions about how to manage the changes that come with perimenopause and menopause. It’s crucial to recognize that many of these physiological changes are not within a woman’s control, and it’s important to let go of the guilt often associated with the symptoms.

Taking a proactive approach, fostering these conversations, and working together with healthcare providers can help women manage these transitions in a way that supports long-term health and well-being.

No woman should have to face concerns about heart disease alone. With Systole Health’s virtual group care, you’ll receive personalized medical care and the warmth of a community to support you every step of the way. Find out more about how Systole Health can support your heart health journey here.

More about Dr. Simin Lee

Simin Lee, MD, MBA, is a practicing cardiologist at Mass General Brigham, specializing in women’s heart health and prevention. She served as the chief cardiology fellow at Brigham and Women’s Hospital, where she developed research interests in behavioral science and innovation in care delivery as well as clinical interests in the unique cardiovascular challenges facing women. 

Outside of her clinical role, she is the founder and CEO of Systole Health, a group virtual care service for women's heart health involving group visits, coaching, and community. Beyond her work as a physician-entrepreneur, she is a mother to two young sons and a competitive marathoner.