Evidence-graded answer
Does GLP-1 increase heart rate?
Modestly — semaglutide raises resting heart rate by about 2-4 beats/min on average, tirzepatide ~3-5 beats/min. The increase is not associated with worse cardiovascular outcomes; the SELECT trial showed semaglutide reduces MACE by 20% despite the HR rise.
Mechanism is incompletely understood; likely a combination of central sympathetic tone changes and reduced parasympathetic tone via gastric vagal pathways.
SELECT (NEJM 2023): semaglutide reduced major adverse cardiovascular events 20% in adults with established CVD + obesity — net benefit despite small HR increase.
Patients with baseline tachycardia (HR >100), uncontrolled atrial fibrillation, or recent acute coronary syndrome should discuss with cardiology before starting.
Source: SELECT NEJM 2023, NEJM