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GLP-1 receptor agonists, such as semaglutide and liraglutide, are increasingly prescribed for type 2 diabetes and weight management in the UK. A common question amongst patients and clinicians is: does GLP-1 raise heart rate? Clinical evidence shows that these medications may cause a modest increase in resting heart rate, typically by 2–4 beats per minute. However, extensive cardiovascular outcome trials have demonstrated that GLP-1 receptor agonists are safe and may even reduce cardiovascular risk. This article examines the relationship between GLP-1 therapy and heart rate, explores the underlying mechanisms, reviews cardiovascular safety data, and provides guidance on when to seek medical advice.
Quick Answer: GLP-1 receptor agonists typically cause a modest increase in resting heart rate of approximately 2–4 beats per minute, which is generally clinically insignificant.
GLP-1 receptor agonists are a class of medications that mimic the action of glucagon-like peptide-1, a naturally occurring hormone in the body. These medicines are primarily prescribed for the management of type 2 diabetes mellitus and, more recently, for weight management in adults with obesity or overweight with weight-related comorbidities.
The mechanism of action involves binding to GLP-1 receptors found throughout the body, particularly in the pancreas, gastrointestinal tract, and brain. When activated, these receptors trigger several beneficial effects:
Enhanced insulin secretion in response to elevated blood glucose levels
Suppression of glucagon release, reducing hepatic glucose production
Delayed gastric emptying, which promotes satiety and reduces appetite
Direct effects on appetite centres in the hypothalamus
Commonly prescribed GLP-1 receptor agonists available in the UK include semaglutide (Ozempic, Wegovy, Rybelsus), dulaglutide (Trulicity), liraglutide (Victoza, Saxenda), and exenatide (Byetta, Bydureon). These medications are administered either as subcutaneous injections (weekly or daily, depending on the formulation) or as oral tablets (Rybelsus).
According to NICE guidance (NG28), GLP-1 receptor agonists are recommended as add-on therapy when glycaemic targets are not met with other treatments. NICE prioritises SGLT2 inhibitors for people with established or high risk of cardiovascular or kidney disease, with GLP-1 receptor agonists considered in specific scenarios, particularly when weight loss is desired. For weight management, NHS use follows specific NICE technology appraisals (such as TA875 for semaglutide and TA664 for liraglutide) and typically requires specialist service involvement.
The MHRA continues to monitor the safety profile of these medications as their use expands. Availability may be subject to local formulary decisions and current supply constraints.
Clinical trials and post-marketing surveillance have identified a modest increase in resting heart rate as a potential effect of GLP-1 receptor agonists. Studies typically report an average increase of about 2–4 beats per minute, though some patients may experience larger increases. Understanding the potential mechanisms behind this observation is important for both patients and healthcare professionals.
The precise physiological mechanisms responsible for heart rate elevation are not fully elucidated, but several hypotheses have been proposed:
Sympathetic nervous system activation may occur as GLP-1 receptors are present in areas of the brain that regulate autonomic function. Stimulation of these receptors could theoretically increase sympathetic outflow, leading to a mild chronotropic (heart rate-increasing) effect.
Compensatory cardiovascular responses to the metabolic changes induced by GLP-1 agonists may also play a role. As these medications promote weight loss and alter fluid balance, the cardiovascular system may adjust heart rate to maintain adequate cardiac output and tissue perfusion.
Direct cardiac effects remain under investigation. Whilst GLP-1 receptors have been identified in cardiac tissue, their functional significance and contribution to heart rate changes are not yet fully understood.
It is important to emphasise that the observed heart rate increases are generally small and clinically insignificant for most patients. The elevation typically occurs gradually over weeks to months of treatment and often stabilises. Large cardiovascular outcome trials have not shown increased arrhythmic events with GLP-1 receptor agonists in the general population. However, individual patient factors, including pre-existing cardiovascular conditions, may influence the clinical relevance of these changes.
Healthcare professionals should consider checking pulse rate at baseline and during follow-up appointments, and investigate other causes of tachycardia if elevations are sustained or symptomatic.
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Despite concerns about heart rate elevation, extensive cardiovascular outcome trials have demonstrated that GLP-1 receptor agonists are not only safe but may offer cardiovascular benefits for many patients. These landmark studies, required by regulatory authorities including the EMA and MHRA, have provided reassuring evidence about the cardiovascular safety profile of this drug class.
Major cardiovascular outcome trials include:
LEADER trial (liraglutide): Demonstrated a significant reduction in major adverse cardiovascular events (MACE) in patients with type 2 diabetes and high cardiovascular risk
SUSTAIN-6 (semaglutide): Showed reduced cardiovascular death, non-fatal myocardial infarction, and non-fatal stroke
REWIND (dulaglutide): Confirmed cardiovascular benefits across a broad patient population
SELECT trial (semaglutide): Showed reduced MACE in people with obesity without diabetes, though this evidence is not yet fully incorporated into UK labelling
These trials consistently found that the modest heart rate increases observed did not translate into adverse cardiovascular outcomes. In fact, the overall cardiovascular risk was reduced in patients treated with GLP-1 receptor agonists compared to placebo. It is worth noting that GLP-1 receptor agonists show neutral effects on heart failure hospitalisation, unlike SGLT2 inhibitors which demonstrate benefit in this area.
The NHS and NICE have incorporated this evidence into clinical guidance (NG28), recognising GLP-1 receptor agonists as valuable therapeutic options for patients with type 2 diabetes. NICE guidance prioritises SGLT2 inhibitors for those with established or high risk of cardiovascular or kidney disease, with GLP-1 receptor agonists as add-on or alternative therapy where appropriate. The cardiovascular benefits of GLP-1 receptor agonists are thought to result from multiple mechanisms, including weight reduction, improved glycaemic control, blood pressure lowering, and potential direct cardioprotective effects.
Patients with pre-existing cardiac arrhythmias or significant cardiovascular disease should be monitored appropriately when initiating GLP-1 therapy, though these conditions are not absolute contraindications. Healthcare professionals should conduct a thorough cardiovascular assessment before prescribing and maintain regular follow-up to ensure treatment remains appropriate and well-tolerated.
Whilst modest heart rate increases are expected with GLP-1 receptor agonists and generally do not require intervention, patients should be aware of symptoms that warrant medical attention. Patient education about recognising concerning cardiovascular symptoms is an essential component of safe prescribing.
Contact your GP or healthcare professional (for example, your GP, pharmacist or diabetes specialist) if you experience:
Palpitations that are persistent, severe, or accompanied by chest discomfort
Dizziness or lightheadedness, particularly if associated with near-fainting episodes
Chest pain or pressure, especially during physical activity
Shortness of breath that is new or worsening, particularly at rest
Unusual fatigue or reduced exercise tolerance
A resting heart rate consistently above 100 beats per minute when measured at rest
For urgent but non-emergency concerns, you can contact NHS 111 for advice.
Seek immediate medical attention (call 999 or attend A&E) if you experience:
Severe chest pain or pressure
Sudden, severe shortness of breath
Fainting or loss of consciousness
Rapid heart rate accompanied by severe dizziness or confusion
For routine monitoring, patients taking GLP-1 receptor agonists should attend regular follow-up appointments as scheduled by their healthcare team. These typically occur at 3–6 month intervals and include assessment of:
Blood pressure and heart rate measurement
Glycaemic control (HbA1c)
Weight and body mass index
Renal function
Tolerability and adverse effects
Patients with pre-existing cardiovascular conditions may require more frequent monitoring or specialist cardiology input. If persistent tachycardia occurs, healthcare professionals may consider further investigations such as ECG, thyroid function tests, electrolytes and medication review.
If you have concerns about heart rate changes or cardiovascular symptoms whilst taking a GLP-1 receptor agonist, do not stop the medication abruptly without consulting your healthcare professional. Your GP or diabetes specialist can assess whether the symptoms are related to the medication and determine the most appropriate course of action.
Patients are encouraged to report any suspected side effects to the MHRA Yellow Card Scheme, which helps monitor the safety of medicines in the UK.
GLP-1 receptor agonists typically increase resting heart rate by approximately 2–4 beats per minute on average, though some patients may experience larger increases. This elevation is generally modest and clinically insignificant for most patients.
Major cardiovascular outcome trials have demonstrated that GLP-1 receptor agonists are safe and may reduce cardiovascular risk. Patients with pre-existing cardiac conditions should be monitored appropriately, though these are not absolute contraindications to treatment.
Contact your GP if you experience persistent palpitations, dizziness, chest pain, new shortness of breath, or a resting heart rate consistently above 100 beats per minute. Seek immediate medical attention (call 999) for severe chest pain, sudden severe breathlessness, or loss of consciousness.
All medical content on this blog is created based on reputable, evidence-based sources and reviewed regularly for accuracy and relevance. While we strive to keep content up to date with the latest research and clinical guidelines, it is intended for general informational purposes only.
DisclaimerThis content is not a substitute for professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare professional with any medical questions or concerns. Use of the information is at your own risk, and we are not responsible for any consequences resulting from its use.
