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Hello there, 

You may know semaglutide (Ozempic®) as a treatment for blood sugar and weight. Earlier this year, we highlighted its broad cardiovascular benefits, showing how it supports blood vessel health beyond metabolism. Now, new research reveals an even more specific role: protecting against atherosclerosis, the root cause of heart attacks and strokes.

A new review in the American Journal of Physiology – Heart and Circulatory Physiology shows that GLP-1 receptor agonists (GLP-1RAs), including semaglutide, help preserve vascular health at the very earliest stages of disease. They do this by improving the function of the endothelium — the delicate inner lining of our arteries — through two main actions: promoting angiogenesis and reducing oxidative stress 

What is the atherosclerosis?

Atherosclerosis begins when the endothelium, the thin inner lining of arteries, becomes dysfunctional. Instead of protecting the vessel, it allows inflammation and oxidative stress to take hold. Over time, fatty deposits and immune cells build up, forming plaques that narrow and stiffen arteries. These plaques can eventually rupture, causing heart attack, stroke, or peripheral artery disease.

How semaglutide helps protect blood vessels

• Promotes angiogenesis (new vessel growth):
  GLP-1RAs stimulate endothelial cells to grow, migrate, and form new microvessels. Clinical studies show that drugs like exenatide increase capillary density and improve microcirculation, while animal studies demonstrate faster recovery of blood flow after vascular injury.

• Mobilizes repair cells:
  These therapies boost endothelial progenitor cells (EPCs) — stem-like cells that act as a repair crew for blood vessels. EPCs help patch damaged areas, rebuild vessel walls, and restore healthy circulation.

• Reduces oxidative stress:
  High blood sugar and excess fats create damaging molecules called reactive oxygen species (ROS) that injure blood vessels. GLP-1RAs lower this oxidative stress while boosting nitric oxide (NO), a natural molecule that relaxes arteries, improves blood flow, and supports vessel health.

• Supporting endothelial survival:
  In laboratory experiments, GLP-1RAs protected endothelial cells from DNA damage, slowed premature cell aging, and improved mitochondrial function — keeping them alive and functional longer.

Why this matters

• Prevents disease at its root: By protecting the endothelium, GLP-1RAs act before plaques fully form.

• Proven clinical impact: Large cardiovascular trials show a 14–20% reduction in major events (heart attack, stroke, cardiovascular death), including in people without diabetes.

• Independent of weight and sugar: These benefits persist even when blood sugar or weight loss changes are modest — pointing to a direct protective effect on arteries themselves.

Angiogenesis and Heart Health

Healthy angiogenesis — the growth of new blood vessels — is essential for repairing vascular damage and maintaining circulation. GLP-1RAs support this process not only by stimulating endothelial cells but also by mobilizing progenitor cells from the bone marrow that help rebuild vessel networks. Together with reduced oxidative stress, this creates stronger, more resilient arteries

The takeaway? Semaglutide may be best known for metabolism, but it also helps blood vessels heal from within. By sparking angiogenesis, mobilizing repair cells, and protecting against oxidative stress, GLP-1 therapies offer a powerful layer of defense against cardiovascular disease.

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Best wishes,
- The Angiogenesis Foundation

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