Journal of cardiovascular pharmacologyJul 28, 2026

Incretin-based treatments, alcohol and tobacco use, and sudden substance-related heart problems: new insights for heart medicine

GLP-1 Therapies Weekly Brief ↗PubMed ↗DOI ↗

Updated Aug 3, 2026

Abstract

Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are associated with lower rates of alcohol-related hospitalization and alcohol use disorder.

Small randomized studies indicate semaglutide may reduce alcohol self-administration and cravings.
Previous trials with exenatide showed no overall benefit, but suggested potential advantages for participants with obesity.
Large registry and electronic health record studies link GLP-1RA exposure with decreased rates of alcohol-related events.
Tobacco use evidence is limited, featuring a pilot trial with exenatide and a link between semaglutide and reduced tobacco-related healthcare encounters.
Preliminary observational analyses report lower rates of opioid overdose, alcohol intoxication, and cannabis use disorder associated with incretin therapies.

Simplified

Glucagon-like peptide-1 receptor agonists (GLP-1RAs) and dual incretin agonists are now familiar drugs in obesity, diabetes, heart failure, and cardiovascular prevention. At the same time, a clinically relevant but molecule-specific human literature suggests that selected incretin-based therapies, particularly semaglutide for alcohol-related outcomes, may also modify alcohol use, tobacco use, and selected acute substance-related events. Alcohol currently has the strongest signal. Small randomized studies suggest semaglutide can reduce laboratory alcohol self-administration and craving, whereas an earlier exenatide trial was neutral overall but suggested benefit in participants with obesity. Large registry and EHR studies further associate GLP-1RA exposure with lower alcohol-related hospitalization, lower incident or recurrent alcohol use disorder, and lower alcohol-related event rates. Tobacco evidence is more limited but now includes a pilot smoking-cessation trial with exenatide and a target-trial emulation linking semaglutide with fewer tobacco use disorder-related healthcare encounters. Evidence beyond alcohol and tobacco, and tirzepatide specific evidence, remains preliminary, although lower rates of opioid overdose, alcohol intoxication, and cannabis use disorder have been reported in observational analyses. For cardiologists, the key question is not whether incretin therapies should be viewed as addiction drugs, but whether established cardiometabolic therapies may also modify cardiovascular relevant risk behaviors.

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PubMed

Incretin-based treatments, alcohol and tobacco use, and sudden substance-related heart problems: new insights for heart medicine

Abstract

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Competing interests

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