Heart risk markers may identify overlooked GLP-1 candidates

Clinical takeaway: Consider remnant cholesterol and inflammatory risk, not BMI alone, when assessing cardiovascular risk in adults with overweight. New observational data suggest that many patients just below current GLP-1 eligibility thresholds may have coronary heart disease risk comparable to those already eligible for treatment.

GLP-1 receptor agonists reduce cardiovascular events in selected patients and can lower both remnant cholesterol and systemic inflammation. However, current weight-management indications generally exclude adults with a BMI of 25.0-26.9, even though some may carry substantial residual cardiovascular risk.

In a pooled analysis of 313,145 adults with overweight from the Copenhagen General Population Study and the UK Biobank, investigators evaluated whether elevated remnant cholesterol, low-grade inflammation, or both could identify individuals at coronary heart disease risk comparable to patients who currently qualify for GLP-1 therapy. The findings, presented at the EASD 2026 Annual Meeting and not yet peer reviewed, included participants who were free of diabetes and coronary heart disease at baseline and were followed for more than 10 years; 23,134 developed coronary heart disease during follow-up.

Approximately two-thirds of participants met current GLP-1 eligibility criteria. Among those with a BMI of 25.0-26.9, roughly half had elevated remnant cholesterol, elevated high-sensitivity C-reactive protein (hsCRP), or both. Individuals who did not qualify for GLP-1 therapy but had elevations in both biomarkers were 41% more likely to develop coronary heart disease in the Danish cohort and 47% more likely in the UK cohort than peers with low levels of both markers.

Notably, this excess risk closely matched that seen among participants who met current GLP-1 eligibility criteria, whose coronary heart disease risk was 35% to 41% higher than that of the lowest-risk reference group. Elevated remnant cholesterol alone was associated with about a 21% to 22% higher risk, while elevated hsCRP alone increased risk by roughly 28% to 39%.

“Our study makes the case for extending the indication to this group,” said lead author Karen Hvid, MD. “Clinical trials are now needed.”

Source: Hvid K, et al. (2026 Sep 28) 62nd EASD Annual Meeting, abstract 704. Elevated remnant cholesterol and hsCRP confer risk of coronary heart disease comparable to GLP-1 RA indication: two studies of 313,000 individuals with overweight