For most of the history of weight-management medicine, one number has decided who gets considered for treatment: body mass index. A study being presented this week at the European Association for the Study of Diabetes (EASD) annual meeting in Milan argues that number is doing a worse job of sorting heart risk than most people assume.
The headlines have framed it as “millions more people could benefit from GLP-1 drugs.” That is a hypothesis the study raises, not a result it produced. Here is what the researchers actually found.
The study
A team led by Dr. Karen Hvid at Copenhagen University Hospital pooled two large, long-running population cohorts: the Copenhagen General Population Study and the UK Biobank. Together they covered 313,145 adults with a BMI of 25 or higher, a median age of 58, roughly half women, all free of coronary heart disease and diabetes when they entered. Participants were followed for up to 18 years in the Copenhagen cohort and up to 15 in the UK Biobank. Over that time, 23,134 developed coronary heart disease.
The researchers then sorted everyone by whether they would meet today’s prescribing criteria for weight-management use of semaglutide or tirzepatide: a BMI of 30 or above, or a BMI of 27 or above with at least one weight-related condition such as high blood pressure or abnormal cholesterol. About two-thirds did. The remaining third, mostly people with a BMI between 25 and 26.9, did not.
What they found
The interesting group is the one outside the criteria.
About half of people with a BMI of 25 to 26.9 (44% in the Copenhagen cohort, 48% in the UK Biobank) had elevated remnant cholesterol, low-grade inflammation, or both. Remnant cholesterol is the cholesterol carried in triglyceride-rich particles, separate from the LDL number most people know. Low-grade inflammation is typically measured with a C-reactive protein blood test. Neither shows up on a scale.
People in that group, outside the criteria but with both markers elevated, were 41% (Copenhagen) and 47% (UK Biobank) more likely to develop cardiovascular disease than people outside the criteria with healthy levels. That excess risk was in the same range as people who do meet current criteria.
The authors’ argument: if the goal of treatment includes protecting the heart, a BMI cutoff alone may be the wrong gate, and a blood test could identify people the cutoff misses.
That fits a broader shift in the field. Earlier this month the Endocrine Society urged researchers to judge obesity treatment by health outcomes rather than weight alone. This study applies similar logic to who is considered in the first place.
What the study does not establish
This is where the headline outruns the data.
Nobody in this analysis was given a GLP-1 to test the idea. It is an observational study of risk. It shows that a group of people outside current criteria carries elevated heart risk. It does not show that a GLP-1 medication would lower that risk in them. The researchers say so directly: clinical trials are needed.
The trial evidence for heart protection comes from a different population. The SELECT trial, which found a 20% reduction in major cardiac events with semaglutide versus placebo, enrolled 17,604 people who already had cardiovascular disease and a BMI of 27 or higher. The people in the Copenhagen analysis had no heart disease at the start, and the group in question sits below that BMI line. Assuming SELECT’s result carries over to them is an extrapolation, not a finding.
Elevated markers and elevated risk are not the same as a diagnosis. A higher average risk across thousands of people does not tell any one person what will happen to them. Plenty of people with high remnant cholesterol never develop heart disease, and plenty of people with normal values do.
Other treatments already target these markers. Elevated cholesterol and inflammation have established management options, from lifestyle changes to lipid-lowering medication. The study does not compare a GLP-1 against any of them.
The details are thin so far. This is a conference presentation. The specific thresholds used for remnant cholesterol and inflammation were not reported in the coverage we could find, and a full peer-reviewed paper will say more about how the groups were defined and adjusted.
The part that applies to compounded medications
SELECT and every other cardiovascular outcomes trial in this space studied branded, manufactured products. That evidence belongs to those products and does not transfer to compounded semaglutide or tirzepatide, which are prepared by state-licensed pharmacies for individual patients. Compounded medications are not FDA-approved and have not been through a cardiovascular outcomes trial. No one should read this study, or SELECT, as evidence that a compounded preparation protects the heart.
This study also does not change who is eligible for treatment through NoBsRx or anywhere else. Eligibility is decided by a licensed provider during an individual assessment, which is why our process starts with a medical review rather than a BMI calculator.
Why this is still worth knowing
The useful takeaway is not about medication at all. It is that BMI is a blunt instrument, and two people with the same number can carry very different risk.
If you have never had a lipid panel that looks beyond LDL, or you don’t know whether inflammation markers have ever been checked, that is a reasonable conversation to have with a licensed clinician, whatever your BMI. Knowing your own numbers is more informative than any population average, including the ones in this study.
This post is general information, not medical advice. It does not describe a benefit of any NoBsRx program and it is not a claim that any medication reduces cardiovascular risk. Compounded medications are not FDA-approved. Treatment is never guaranteed. Eligibility, diagnosis, and every treatment decision are made by independent licensed providers based on an individual clinical assessment, and availability varies by state. Do not start, stop, or change any medication based on an article. If you have questions about your heart health, talk to a licensed clinician.