High Cholesterol: Can GLP-1s Reduce Low-Density Lipoprotein?

Posted on September 2, 2026 by Sally-Anne Turner

It’s in the background of many cardiovascular diseases and was a huge part of the health drive of the 1990s: cholesterol. Low-cholesterol meals, cod liver oil, and exercise regimens were focused on lowering body fat levels, all to reduce the risk of developing secondary heart issues.

There is research by NHS England (2023/2024) that indicates if you have higher levels of cholesterol, you are at a higher risk of developing cardiovascular issues. However, while it would be easy to assume excess weight is the leading cause of high cholesterol, recent NHS research found that as many as 41-46% of people with a normal BMI UK have raised cholesterol.

As we know, GLP-1s in the UK can only be prescribed to those with a BMI of 27 or higher. But people who are overweight tend to have slightly raised cholesterol. So, can this medication help to prevent heart issues in the background, while also shedding weight?

At the Bodyline Clinic, we have the clinical expertise and medical insight to help people with specialised needs to lose weight. We offer targeted and personalised clinical care to oversee GLP-1 usage in patients who may have cardiovascular disease, to keep them safe through their weight loss journey. With over 18 years of experience and over 100,000 people in the UK helped by our team, we know what we are doing in this area!

So, let’s take a look at cardiovascular disease, the role that cholesterol plays and whether GLP-1s can help to reduce cholesterol during weight loss treatments.

What is Cholesterol?

Starting at the top, what is cholesterol?

Cholesterol is a lipid (fat) that is found in every cell in the body, and it is produced by the liver. According to the National Institute for Health and Care Excellence, or NICE, there are two main types of cholesterol. The first is low-density lipoprotein, LDL, or non-HDL cholesterol. This is known as the “bad” cholesterol and is linked to the risks we will look at later. Then there is high-density lipoprotein, or HDL, which is known as good cholesterol.

If somebody has a high level of LDL in their system, this can increase plaque buildup in the arteries, leading to heart disease. If you have an optimal HDL level, or normal cholesterol levels UK, this can reduce your risk of heart disease, as HDL transports cholesterol from the arteries to the liver, where it can be broken down.

Causes of High Cholesterol

It has been assumed that being overweight or obese was the only cause of high cholesterol.

However, this is not the case, and it is a bit more complex than solely being linked to diet. Causes of high LDL cholesterol can include

1. Genetics. This is known as familial hypercholesterolemia.
2. Eating foods high in saturated fats, salt and sugar. Also, processed foods increase the risks.
3. Smoking. Even being in a room with second-hand smoke is not ideal.
4. Having excess body weight.
5. Having a sedentary lifestyle and a lack of activity.
6. Metabolic syndrome. These can include the risks of heart disease, strokes and diabetes.

So, it is a bit more complex than looking into how to lower cholesterol with diet. There are multiple things that can create cholesterol and cause it to increase with age. But of course, low cholesterol foods can help to reduce it!

Cholesterol and Secondary Heart Issues

As before, cholesterol is not something that the majority of weight loss clinics test for when you approach them for GLP-1 treatments.

However, high cholesterol is one of the most significant risk factors for cardiovascular disease. Indeed, around one third of ischaemic heart disease globally can be linked to high cholesterol, according to NHS England. There is also evidence that excess weight can compound cardiovascular risk in people with high cholesterol. A 2024 study of adults with familial hypercholesterolaemia found that obesity was independently associated with higher odds of established coronary artery disease.

So, if you have heart issues and are overweight, it is more likely that you have high cholesterol. Meaning that when you approach a weight loss clinic for GLP-1’s, you are more likely to be turned away due to cardiovascular conditions.

Indeed, higher levels of cholesterol and being either overweight or obese are linked to the following conditions.

Coronary Artery Disease (CAD)

LDL cholesterol increases the chance of plaques (fatty blockages) forming in the arteries. Now, being obese is associated with having more plaques, as well as non-HDL cholesterol.

Recent research from the Obesity Medicine Association and National Lipid Association (2024) has concluded that obesity increases cardiovascular disease due to the higher level of plaques. So, in other words, if you have higher cholesterol and are obese, your chances of cardiovascular disease, specifically coronary artery disease, are higher.

Heart Attacks (myocardial infarctions)

These are likely to occur when a plaque in an artery becomes unstable and causes a blood clot to form. The blood clot then blocks flow to part of the heart, cutting off the flow and causing a heart attack. Having high LDL cholesterol is a risk factor, but it is not the only one. Another risk is dyslipidaemia, high blood pressure and insulin resistance, and of course type 2 diabetes.

What’s particularly interesting is that obesity doesn’t need to be accompanied by high levels of LDL cholesterol to increase cardiovascular risk. The metabolic changes that occur due to excess adiposity can contribute directly to cardiovascular disease, so based on research in the 2024 OMA/NLA review, it is wise to address both of these conditions to prevent heart attacks.

Ischaemic stroke

Ischemic strokes occur when the blood vessels that are supplying the brain become blocked. This is also often the result of atherosclerosis or a blood clot. As before, abnormal or high lipid profiles have been linked with an increased stroke risk, particularly in ischemic stroke.

You may be noticing a pattern here. The relationship isn’t simply that excess weight causes high cholesterol, but there is an interwoven set of risk factors that can contribute to the development of cardiovascular disease, and cholesterol is one of the most noted ones.

Do GLP-1s lower Cholesterol?

This is where it gets interesting. Of course, compared to standard treatment for high cholesterol, such as statins, GLP-1’s may not be as impressive. But consider that lowering LDL is not what these medications were designed for.

We know that many pharmacies will turn people away if they have cardiovascular disease for GLP-1 treatment. However, there is recent evidence that taking GLP-1s has a favourable outcome on lipids, thereby potentially reducing heart disease risks long-term.

The two core contenders here are semaglutide (Wegovy and Ozempic) and tirzepatide (Mounjaro).

A study from the SELECT trial, published in the New England Journal of Medicine in 2023, looked at over 17,000 adults who were overweight or obese but did not have diabetes. They did, however, have established cardiovascular disease.

Lipids were explored in two groups: placebo and one group taking 2.4mg of semaglutide.

The results showed:

1. Total cholesterol: -2.77 percentage points.
2. LDL cholesterol: -2.18 percentage points.
3. Triglycerides: -15.64 percentage points.
4. HDL cholesterol: +4.24 percentage points.

So, the LDL (bad) cholesterol dropped, and the HDL (good) improved. This is likely due to reduced inflammation, but interestingly, a similar result was found with Mounjaro.

A meta-analysis of trials using tirzepatide has found reductions in overall cholesterol and LDL. This was across 5mg, 10 mg, and 15mg doses. At the highest dose, the reductions, when compared to the placebo group, were:

1. Total cholesterol: −0.37 mmol/L
2. LDL cholesterol: −0.24 mmol/L
3. Triglycerides: −0.43 mmol/L

Again, the HDL (or good) cholesterol increased. These findings were also backed by the SURMOUNT-3 trial, which noted similar findings with tirzepatide and non-HDL cholesterol.

So, this begs the question: what’s going on?

1. Reduced Liver Lipid Production

GLP-1 receptor activation appears to influence how the liver handles fats. This may reduce the accumulation of triglyceride-rich lipoproteins, which can help them break down, while minimising circulating LDL.

2. Improved insulin sensitivity

These oral or injectable weight loss medications improve glucose regulation and, for those with insulin resistance, reduce the flow of fats in the body and target them to the liver. Again, this speeds up the breakdown and removal, meaning they can’t build up!

3. Changes in Intestinal Lipid Absorption

GLP-1 signals gastrointestinal function, which includes gastric emptying. However, it may also signal intestinal lipid handling, which can alter post-meal lipoprotein production. This means less dietary fat can appear in circulation, reducing cholesterol.

4. Effects on adipose tissue

These treatments are designed to promote weight loss and, as fat mass decreases (in particular, visceral fat), there are fewer free fatty acids in the bloodstream.

5. Reduced inflammation

Obesity is linked to low-grade inflammation, which has an impact on lipid metabolism and cardiovascular risks. As we have seen before, GLP-1s like the Wegovy pill appear to have anti-inflammatory effects, which may impact how the body processes fats and is one of the more interesting Wegovy side effect.

Heart Disease and How Bodyline Helps

It can be hard to get access to GLP-1 medications when you have pre-existing medical conditions. And if you have heart problems, it can be even harder. Our clinical team at the Bodyline Clinic has 18 years of expertise to oversee your medical treatment with any weight loss medication. This will ensure that you are safe throughout the duration and that you meet your weight loss goals. We will work with any specialists or consultants who are helping you with your heart condition, to make sure that we all achieve the best outcomes for you.

So, if you want to start losing weight but have concerns about heart issues, contact our team today for a free consultation.

FAQS

What is Cholesterol?

Cholesterol is a lipid (fat) that is found in every cell in the body. It is made in the liver. There is LDL cholesterol, which people refer to as bad cholesterol, and then there is HDL, which is known as good cholesterol.

Can GLP-1’s Reduce Cholesterol?

At the time of writing, GLP-1s are not prescribed to reduce cholesterol. However, in both the SELECT trial and the SUMOUNT 3 trial, semaglutide and tirzepatide were noted to reduce LDL cholesterol and increase HDL (good) cholesterol.

Does Cholesterol impact Heart Health?

There is a strong link between having excess LDL cholesterol and having heart disease. So, if you have a cardiovascular issue, it is likely that you will have excess LDL, depending on the conditions that you have.