A large Danish analysis presented at the European Association for the Study of Diabetes (EASD) annual meeting in Milan, Italy (September 28 to October 2, 2026) argues that current eligibility criteria for GLP-1 receptor agonist therapy may be drawing the line in the wrong place for cardiovascular risk. The research, led by Dr. Karen Hvid of Copenhagen University Hospital, Herlev, draws on data from 313,145 people with overweight (BMI of 25 or above), pooled from two long-running prospective studies: the UK Biobank and the Copenhagen General Population Study.

What the Researchers Looked At

All participants were free of coronary heart disease and diabetes at the start of the study, with a median age of 58 and an approximately even split between men and women. Over follow-up periods ranging from 10 to 18 years, 23,134 of them went on to develop coronary heart disease. The researchers specifically examined two biomarkers known to signal cardiovascular risk independent of body weight alone: remnant cholesterol (a marker of triglyceride-rich lipoproteins) and low-grade inflammation.

The Key Finding

Roughly 44% to 48% of people in the lower-overweight range studied, BMI 25 to 26.9, had elevated remnant cholesterol and/or low-grade inflammation despite falling below the BMI thresholds that currently make someone eligible for GLP-1 therapy under most prescribing guidelines. When the researchers compared coronary heart disease risk between these two groups, they found the risk was closer than current eligibility criteria would suggest: people with elevated biomarkers but below the eligibility threshold showed roughly 41% to 47% increased cardiovascular risk, compared to 35% to 41% among people who were already eligible for GLP-1 treatment under existing criteria.

What the Researchers Are Proposing

The analysis argues for extending GLP-1 receptor agonist eligibility to include a meaningful share of adults in the BMI 25 to 26.9 range specifically when they also carry elevated remnant cholesterol or inflammation markers, on the reasoning that their cardiovascular risk profile already resembles that of patients current guidelines do cover. It's an argument about who should qualify for prescription, not a claim that GLP-1 drugs work differently or more powerfully than already documented.

Reading This Cautiously

This is registry and cohort data, not a randomized controlled trial testing whether prescribing GLP-1 drugs to this specific lower-BMI, biomarker-positive group actually reduces their heart disease incidence. Observational associations between risk markers and outcomes, however well-powered, are a different kind of evidence than a trial that randomizes people to treatment and placebo and measures results. Any change to formal prescribing guidelines or FDA-labeled indications would require that kind of interventional evidence, along with regulatory review, and this presentation doesn't represent either of those things happening. It's a conference presentation proposing a hypothesis for further study, not a change in what's currently approved or covered by insurance.

The Bottom Line

The Copenhagen-led analysis adds to a growing body of research questioning whether BMI alone is the right gatekeeper for GLP-1 eligibility, pointing instead toward combining weight with specific bloodwork markers. It's a genuinely large dataset and a serious research question, but it's early-stage evidence about a policy question, not a new treatment recommendation. Anyone curious whether they might benefit from GLP-1 therapy, regardless of where they fall on a BMI chart, should discuss their specific risk factors and bloodwork with a physician rather than self-diagnosing eligibility from a headline.