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The final manuscript was reviewed by experts in endocrinology, nephrology, and cardiology, who provided critical feedback and ensured comprehensive bibliographic coverage
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If a patient is still on 0.5 or 1 mg weekly semaglutide and has hit a stall, moving to 1.7 or 2.4 mg often resolves it without adding another compound
1).29,32 With respect to the vascular system, rGLP-1 activation induces modest decreases in blood pressure,33,34 it has a vasodilator effect, improves arterial stiffness, and prevents atherosclerotic plaque formation-and has plaque stabilizing effects-through its anti-inflammatory and antiapoptotic effects as demonstrated in animal models.29,32,3538 Despite controversies about rGLP-1 expression in vascular smooth muscle and endothelial cells, studies have shown that arGLP-1 has antiproliferative effects on these cells,39 reduces oxidative stress, improves endothelial function, and increases nitric oxide production in experimental models.3540 In the heart they produce a discrete increase in heart rate (24 beats/min), although this does not seem to be associated with an increase in arrhythmias or cardiovascular events
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