Retatrutide and Heart Health: The Short Version

In the trials that reported them, retatrutide lowered blood pressure, triglycerides, non-HDL cholesterol and hsCRP, a marker of inflammation, on average. In TRIUMPH-1, the largest trial with results so far, published in full in September 2026, systolic blood pressure fell by 10.4 mmHg on the highest dose over 80 weeks, against 1.9 mmHg on placebo.

Blood pressure sometimes fell too low. In the same trial, low blood pressure was reported as a side effect in 8.8% of participants on the highest dose and 0.9% on placebo, more often in people who were also taking blood pressure medicines; the investigators described these events as mostly mild or moderate and nonserious. Retatrutide also raises heart rate.

Whether any of this means fewer heart attacks and strokes is not known. TRIUMPH-3, in people with established cardiovascular disease, counted cardiovascular events, but there were too few to show a difference from placebo in either direction. A dedicated outcomes trial with an enrollment goal of 10,000 people is expected to finish in February 2029.

Does Retatrutide Lower Blood Pressure?

On average, yes. Average systolic blood pressure fell rather than rose on retatrutide in every trial in the table below:

The sources used here give placebo figures for three of these trials, and in each the fall on 12 mg was larger than on placebo. In TRIUMPH-1, systolic pressure fell by 10.4 mmHg on 12 mg and 1.9 mmHg on placebo over 80 weeks, and by 7.6 and 9.8 mmHg on 4 mg and 9 mg; blood pressure was a key secondary outcome, tested with control for multiple testing, and all three doses differed from placebo. In TRANSCEND-T2D-1, it fell by 6.4 mmHg on 12 mg against 1.6 mmHg on placebo at 40 weeks; Lilly says these comparisons were controlled for multiple testing on the 9 mg and 12 mg doses. In the Phase 2 trial, it fell by 9.4 mmHg on 12 mg against 3.4 mmHg on placebo at 24 weeks, and by 8.8 against 2.9 mmHg at 36 weeks; diastolic pressure changed less, falling by 2.5 mmHg on 12 mg and 1.7 mmHg on placebo at 24 weeks.

The numbers are not directly comparable. The TRIUMPH-1 figures come from the published paper and use the treatment-regimen estimand, which counts every participant whether or not they kept taking the drug; the company's earlier announcement had given a larger figure, up to 12.3 mmHg, using the efficacy estimand, which estimates the effect had everyone stayed on treatment. For TRIUMPH-2, TRIUMPH-3 and TRIUMPH-4, Lilly's announcements give figures for retatrutide only, without placebo figures or a stated reference point; the TRIUMPH-2 and TRIUMPH-4 figures use the efficacy estimand, the TRIUMPH-3 announcement does not say which estimand its blood pressure and lipid figures use, and the TRIUMPH-4 figure was not adjusted for testing several outcomes at once. The TRANSCEND-T2D-1 figures use the efficacy estimand, and the Phase 2 figures are 24-hour averages from ambulatory blood pressure monitoring.

Low Blood Pressure and Blood Pressure Medication in the Trials

In TRIUMPH-1, hypotension, which the trial counted together with orthostatic hypotension (a drop on standing) and decreased blood pressure, was reported in 2.7% of participants on 4 mg, 5.3% on 9 mg and 8.8% on 12 mg, against 0.9% on placebo; the investigators described these events as mostly mild or moderate and nonserious. Dizziness was reported in 5.0%, 8.9% and 12.0%, against 3.1% (see retatrutide side effects). The investigators wrote that dizziness and reported symptoms of hypotension appeared to be dose-dependent, and that reported hypotension was more common in participants who were also taking blood pressure medicines.

The Phase 2 obesity trial reported what happened to blood pressure medicines. The investigators wrote that improvements in blood pressure during the 48 weeks of treatment led to at least one blood pressure medicine being stopped in 41% of participants in the combined 8 mg groups and 30% of those on 12 mg, without saying what these percentages are out of. In that trial, low blood pressure was reported as an adverse event in 6 of 267 participants on retatrutide and none of the 70 on placebo, and dizziness in 8.1% of those on 12 mg against 2.9% on placebo.

Cholesterol, Triglycerides and Inflammation

A dash means the figure is not given in the sources listed below. The TRIUMPH-1 row comes from the published paper; the TRIUMPH-2, TRIUMPH-3 and TRIUMPH-4 rows come from Lilly's announcements and give no placebo figures. The Phase 2 trial reported LDL and total cholesterol rather than non-HDL cholesterol: at 48 weeks, LDL cholesterol fell by 21.7% on 12 mg against 0.3% on placebo, and total cholesterol by 17.8% against a 1.9% rise on placebo.

Among lipids, triglycerides fell the most, by roughly 30% to 40% on the highest doses, and hsCRP fell by more than half on the highest dose in the three TRIUMPH trials for which a figure is given here. In TRIUMPH-1, hsCRP also fell by about a quarter on placebo (24.9%), against 62.6% on 12 mg. The TRIUMPH-1 announcement had given larger figures for triglycerides and non-HDL cholesterol (up to 41.0% and 24.2%) using the efficacy estimand. In TRANSCEND-T2D-1 the largest reductions were on 9 mg rather than 12 mg: 39.6% for triglycerides and 19.8% for non-HDL cholesterol.

HDL cholesterol, the kind usually considered protective, did not improve in the same way in the Phase 2 trial. There it was 8.4% lower than at the start on 12 mg at 24 weeks, against 0.4% higher on placebo. By 48 weeks it was 2.5% above the starting level, less than the 5.2% rise on placebo, and the investigators described improvements in lipids "with the exception of" HDL cholesterol.

Does Retatrutide Reduce Heart Attacks and Strokes?

That has not been shown. Lower blood pressure and cholesterol are generally linked to fewer cardiovascular events, but improvements in these measures do not always translate into fewer events, so the only way to know is to count heart attacks, strokes and deaths in large, long trials.

Lilly reported a pre-specified analysis of cardiovascular events from TRIUMPH-3, which enrolled 1,949 people with a BMI of 35 or more and established cardiovascular disease. Half the participants were randomized to placebo and half to retatrutide 9 mg or 12 mg. There were 27 major adverse cardiovascular events (cardiovascular death, heart attack or stroke) among participants randomized to retatrutide and 23 among those randomized to placebo, a hazard ratio of 1.12 (95% confidence interval 0.64 to 1.96). On a broader measure covering death from any cause, heart attack, stroke, heart failure events and coronary revascularization, there were 44 and 52, a hazard ratio of 0.82 (0.55 to 1.22). The company said these events occurred less often than anticipated in both groups.

A hazard ratio below 1 favors retatrutide and above 1 favors placebo, and when the confidence interval spans 1, the result is compatible with no difference. That is true of both results, and of an analysis that was not pre-specified, which left out events more than 35 days after a participant stopped treatment: hazard ratios of 0.73 (0.47 to 1.12) on the broader measure and 0.92 (0.51 to 1.65) on the narrower one. The trial therefore cannot show whether retatrutide raises or lowers cardiovascular risk.

The other trials had very few major cardiovascular events. In TRIUMPH-1, adjudication-confirmed major adverse cardiovascular events occurred in 1, 5 and 3 participants on 4 mg, 9 mg and 12 mg, against 1 on placebo, with about 580 participants in each group; the investigators wrote that the trial was not powered to assess cardiovascular safety. In TRANSCEND-T2D-1, a 40-week trial in type 2 diabetes, such events occurred in three participants, all on 4 mg. Numbers this small cannot show an effect in either direction.

Four participants on retatrutide and two on placebo died in TRIUMPH-1. One death, on 12 mg, was adjudicated as cardiovascular; it occurred in a participant with known heart failure 189 days after stopping retatrutide. The others were a motor vehicle accident and two sudden deaths, one noncardiovascular and one of undetermined cause, on 9 mg, and a motor vehicle accident and a gunshot wound on placebo.

For comparison, semaglutide 2.4 mg has a completed outcomes trial. SELECT, a different and much larger trial, enrolled 17,604 adults aged 45 or older with overweight or obesity and established cardiovascular disease but no diabetes, followed them for up to five years, and found a 20% lower risk of major adverse cardiovascular events than on placebo. Retatrutide's equivalent is TRIUMPH-Outcomes, which has an enrollment goal of 10,000 adults aged 45 or older with a BMI of 27 or more and atherosclerotic cardiovascular disease, chronic kidney disease or both. It is designed to determine whether retatrutide lowers serious heart-related complications or prevents worsening kidney function, and is expected to finish in February 2029.

Heart Rate and Heart Rhythm

Retatrutide raises heart rate. In TRIUMPH-1, the mean pulse rate rose on retatrutide, peaking at 20 weeks on 9 mg and 12 mg and decreasing after that. In the Phase 2 trial, measured as a 24-hour average, heart rate on 12 mg was 9.2 beats per minute higher than at the start at week 24, against 0.8 on placebo, and 6.7 against 0.9 at week 36; the investigators reported that it rose with dose up to week 24 and declined after that. The data are covered in more detail in why retatrutide increases heart rate.

In TRIUMPH-1, severe or serious arrhythmias or cardiac conduction disorders were reported in 0.2% to 0.9% of participants on retatrutide, depending on the dose, and 0.9% on placebo. In the Phase 2 trial, cardiac arrhythmias of any severity (a category that included supraventricular arrhythmias and cardiac conduction disorders) were reported in 11% of participants on 12 mg and 3% on placebo; the investigators described them as mild to moderate, except for one severe case of QT prolongation in a participant being treated with ondansetron, an anti-nausea medicine. In TRANSCEND-T2D-1, arrhythmias and conduction disorders were reported in 1% to 3% of participants on retatrutide, depending on the dose, and none on placebo.

Semaglutide, a GLP-1 drug, also raises heart rate, and its US label for weight management lists heart rate increase among its warnings.

What Is Still Unknown

• Whether retatrutide reduces heart attacks, strokes or cardiovascular deaths, the question TRIUMPH-Outcomes is designed to answer.
• How blood pressure and lipids change after treatment stops.
• What the heart rate increase means over years of use (see retatrutide long-term safety).

Why This Page Has No Treatment Advice

Some articles on this topic suggest heart monitoring schedules, dose changes based on heart rate, or combining retatrutide with blood pressure and cholesterol medicines. This one does not give guidance on any of these. Retatrutide has no approved label, so there is no approved guidance on how it should be monitored, dosed or combined with other medicines.

Products sold online under the retatrutide name are not sold or supplied by Lilly. The company's retatrutide page (updated September 2026) says it is legally available only through its clinical trials; in August 2026 the company said it would also make it available to a limited number of patients who meet specific medical criteria and cannot enroll in a trial. It warns that illicit products "may contain unknown ingredients, harmful contaminants and impurities," so their effects on blood pressure or the heart cannot be inferred from the trial results.

Retatrutide and Heart Health in Summary

On average, systolic blood pressure fell on retatrutide in every retatrutide trial with results covered here. In TRIUMPH-1, it fell by 10.4 mmHg on 12 mg against 1.9 mmHg on placebo over 80 weeks, and in the two other trials for which placebo figures are given here, the fall on 12 mg was about 5 to 6 mmHg larger than on placebo. Blood pressure sometimes fell too low: low blood pressure, mostly mild or moderate, was reported in 8.8% of TRIUMPH-1 participants on 12 mg against 0.9% on placebo, more often in those also taking blood pressure medicines. Retatrutide also reduced triglycerides, non-HDL cholesterol and hsCRP, and raised heart rate. Whether these changes prevent heart attacks and strokes has not been shown: the trials so far have had too few cardiovascular events to show an effect, and the dedicated outcomes trial is expected to finish in February 2029.

Sources

• Jastreboff AM, Kaplan LM, Davies MJ, et al. Retatrutide, a Triple Hormone Receptor Agonist, for Treatment of Obesity. N Engl J Med. Published September 29, 2026. DOI: 10.1056/NEJMoa2604169. (TRIUMPH-1)
• Eli Lilly. Lilly's triple agonist, retatrutide, drove substantial improvements in weight, A1C, knee osteoarthritis pain, and obstructive sleep apnea, demonstrating its remarkable potential to treat obesity and its complications. June 6, 2026.
• Eli Lilly. Lilly's triple agonist, retatrutide, delivered weight loss of up to an average of 71.2 lbs along with substantial relief from osteoarthritis pain in first successful Phase 3 trial. December 11, 2025.
• Eli Lilly. Lilly's triple agonist, retatrutide, successful in two additional Phase 3 obesity trials, delivering significant improvements in weight and A1C. July 23, 2026.
• Eli Lilly. Lilly's triple agonist, retatrutide, delivered substantial weight loss and A1C reduction, underscoring its potential promise for people with obesity and type 2 diabetes. September 29, 2026.
• Lilly Medical. What are the results of monotherapy retatrutide in patients with type 2 diabetes from TRANSCEND-T2D-1? Last reviewed May 18, 2026.
• Jastreboff AM, Kaplan LM, Frías JP, et al. Triple–Hormone-Receptor Agonist Retatrutide for Obesity — A Phase 2 Trial. N Engl J Med. 2023;389(6):514–526, and supplementary appendix (Tables S6, S8 and S10).
• Eli Lilly. ADA 2026 congress materials for healthcare professionals: TRANSCEND-T2D-1 (lilly.com/hcp). June 2026.
• Lilly Trials. The Effect of Retatrutide Once Weekly on Cardiovascular Outcomes and Kidney Outcomes in Adults (TRIUMPH-Outcomes). NCT06383390, trial listing.
• Novo Nordisk. Semaglutide 2.4 mg reduces the risk of major adverse cardiovascular events by 20% in adults with overweight or obesity in the SELECT trial. August 8, 2023.
• Novo Nordisk. Wegovy (semaglutide) US prescribing information, section 5. Revised June 2026.
• Eli Lilly. What to know about retatrutide. Last updated September 2026.
• STAT. Eli Lilly to allow more patients to apply for special access to unapproved obesity drug. August 3, 2026.

Medical Disclaimer: This article is for informational purposes only and is not medical advice. Retatrutide is investigational and is not approved by the FDA for any use, including reducing cardiovascular risk. It is not available by prescription, and products sold online under its name are not sold or supplied by Lilly. Changes in blood pressure and cholesterol do not prove a reduction in heart attacks or strokes. Nothing here is a recommendation to use, seek out or avoid any medication.