Ziyad Al-Aly, MD ✓
@zalaly · United States · joined 26 Feb 2009
Physician-Scientist | TIME100 Health https://t.co/AXG4WotuRc Profile: https://t.co/ywweQn5DHA…
31 805Followers
936Following
3 369Posts total
444.8KViews on collected posts
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Can Ozempic prevent cancer? Several large studies suggest it might. But the excitement is running ahead of the evidence.
In @ConversationUS, I explain what the evidence actually shows and why these studies are so easy to misread.
https://t.co/a9HMPM7CzG
2.9K views · 22 likes
· 8 reposts · 3 replies
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GLP-1 drugs are associated with a 35% higher risk of NAION, an eye condition that can cause sudden vision loss.
About 6 to 10 extra cases per 10,000 users over 3 years.
The association is specific to NAION. No other eye conditions were affected. https://t.co/9PXIMgH538
25.7K views · 121 likes
· 23 reposts · 15 replies
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I am watching the hantavirus outbreak carefully.
The probability of human to human transmission is low, but it is unwise to rule it out.
The ship sailed from Argentina where Andes virus, the only hantavirus with documented human to human transmission, is endemic. https://t.c
14.3K views · 206 likes
· 50 reposts · 29 replies
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@zalaly @JAMANetworkOpen Your discussion doesn’t include that the VA had very strict criteria for who could receive a GLP-1 during the timeframe of your study. Individuals had to have an uncontrolled A1c and be on at least two oral diabetic medications (one of which had to be met
1.3K views · 33 likes
· 0 reposts · 3 replies
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What this means clinically:
The absolute risk is low. But NAION can be serious. Patients starting GLP-1 drugs should know to seek urgent care for changes in vision.
Clinicians should counsel patients on this risk, especially those at high baseline risk of NAION.
2.7K views · 27 likes
· 3 reposts · 1 replies
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Led by @Biostayan and Taeyoung Choi. Full paper in @JAMANetworkOpen
https://t.co/ajFxjpk7SH
2.6K views · 19 likes
· 0 reposts · 6 replies
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Why we think this is real, not a fluke.
Two alternative explanations to rule out:
1. People on GLP-1 drugs may see eye doctors more often and pick up incidental diagnoses.
2. GLP-1 drugs may cause general eye problems, with NAION just one of them.
We checked. Neither held up.
▸
2.4K views · 15 likes
· 1 reposts · 4 replies
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But was the signal real, or just noise from the way we defined NAION?
We tested it three more ways:
▸ Diagnosed by an eye-care specialist: 8.7 extra cases per 10,000)
▸ Repeated NAION diagnoses: 6.4 extra cases per 10,000)
▸ Specialist-diagnosed plus repeated: 5.9 extra cases
2.1K views · 11 likes
· 0 reposts · 1 replies
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At 3 years, NAION was more frequent among people who started GLP-1 drugs:
▸ GLP-1 drugs: 39.1 cases per 10,000 persons
▸ SGLT2 inhibitors: 29.3 cases per 10,000 persons
That works out to 6 to 10 extra cases per 10,000. A 35% higher risk on GLP-1. https://t.co/RnayJqA972
5.6K views · 29 likes
· 7 reposts · 6 replies
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Do GLP-1 drugs increase the risk of vision loss?
Specifically, a condition called NAION: a sudden loss of blood flow to the optic nerve that can cause vision loss.
We looked at this in 588,000 people.
The answer, in our new @JAMANetworkOpen paper, is yes. 🧵
43.9K views · 237 likes
· 78 reposts · 17 replies
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We used VA data to emulate a target trial.
588,168 adults with type 2 diabetes:
▸139,546 started a GLP-1 drug
▸ 448,622 started an SGLT2 inhibitor
▸ Followed for up to 3 years
3.5K views · 11 likes
· 0 reposts · 3 replies
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@zalaly @BMJMedicine This is a glass half full argument.
If you exercise you improve CV and when you stop the benefits disappear quickly.
Continuation is the answer
1.2K views · 13 likes
· 0 reposts · 1 replies
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The heavy lifting here was done by the amazing @biostayan
Press release by the wonderful Shawn Ballard: https://t.co/XgMSFA4rk2
@WashUMedicine @WashU @VAResearch
Paper:
https://t.co/2IOeQ7R1SS
5.3K views · 57 likes
· 12 reposts · 11 replies
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Weight regain is visible. The metabolic reversal is not.
Stopping can undo years of heart protection. https://t.co/MGV3AdqKhg
5.6K views · 60 likes
· 15 reposts · 1 replies
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When people stop GLP-1 drugs, it’s not just weight that comes back. They experience a resurgence in inflammation, blood pressure, cholesterol, and insulin resistance.
Weight regain is visible. The metabolic reversal is not.
We think of this as a form of metabolic whiplash.
6.5K views · 89 likes
· 16 reposts · 8 replies
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GLP-1 drugs are not short-term treatments. They are long-term treatments, and patients, providers, and insurers all need to reckon with that. Stopping can undo years of accrued heart protection. https://t.co/KmL9TRpvd2
5.9K views · 96 likes
· 18 reposts · 2 replies
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This happened in the VA system, where copays are capped at $11/month. Over a quarter of users still discontinued entirely. Nearly another quarter had interruptions.
Cost matters — but it is far from the only reason people stop.
5.8K views · 45 likes
· 5 reposts · 1 replies
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Restarting helped — but didn’t fully restore the protection of uninterrupted use.
Discontinuation leaves a lasting scar.
11.8K views · 60 likes
· 7 reposts · 2 replies
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Using the drug for 0.5, 1, or even 1.5 years and then stopping produced no significant cardiovascular benefit at 3 years.
The risk ratios were close to 1.0 — as if the drug had never been taken. https://t.co/eU8EvLl2pH
6.5K views · 54 likes
· 5 reposts · 2 replies
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Here is the most striking finding:
What 3 years of continuous treatment builds, a year and a half off the drug can undo.
Protection accumulates slowly. It unravels quickly. That asymmetry may be the single most important clinical implication of this study. https://t.co/Gt24Vd4uCZ
7.3K views · 91 likes
· 11 reposts · 2 replies
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The core finding: Cardiovascular protection builds slowly. It took 3 years of continuous GLP-1 use to achieve an 18% reduction in heart attack, stroke, and death.
But that protection erodes fast.
8K views · 64 likes
· 11 reposts · 1 replies
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Stopping for 6 months: 4% increased risk
Stopping for 1 year: 14% increased risk
Stopping for 2 years: 22% increased risk
— all compared to staying on. https://t.co/PcTszl7om8
7.6K views · 63 likes
· 11 reposts · 2 replies
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About 1 in 8 U.S. adults has taken a GLP-1 drug. But 36–81% of users stop within the first year. Most studies have focused on weight regain after stopping. We focused on what happens to the heart. https://t.co/Rnosn6NqKh
11.3K views · 78 likes
· 16 reposts · 2 replies
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We followed 333,000+ adults with type 2 diabetes for 3 years, emulating a randomized trial across 16 treatment scenarios with different durations of use, discontinuation, and interruption.
8.4K views · 42 likes
· 4 reposts · 1 replies
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What happens to the heart when people stop GLP-1 drugs?
The short answer: nothing good.
New from our team: a study of 330,000+ people in @BMJMedicine
🧵 https://t.co/vO29pJaRT3
246.5K views · 587 likes
· 151 reposts · 47 replies
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Growth & engagement
How the posts we collected actually performed: views and reaction rate post by post, what the audience did with them, and where the follower count goes.
Views per post
5.6K18 Mar
5.3K
1.2K
3.5K4 May
43.9K
5.6K
2.1K
2.4K
2.6K
2.7K
1.3K
14.3K5 May
25.7K6 May
2.9K13 Jul
Last 14 collected posts, oldest on the left. The scale is logarithmic: one post can outrun the rest a hundred times over.
Engagement rate per post
1.36%18 Mar
1.50%
1.14%
0.40%4 May
0.79%
0.75%
0.56%
0.84%
1.00%
1.14%
2.78%
2.03%5 May
0.63%6 May
1.14%13 Jul
Reactions — likes, reposts, replies and quotes — divided by views.
What the audience does
Likes59.4%2 130 in total
Reposts12.6%452 in total
Replies4.8%171 in total
Quotes1.7%62 in total
Bookmarks21.4%768 in total
Share of every reaction we collected for this account. Replies mean argument, reposts mean endorsement, bookmarks mean the post was worth keeping.
The follower curve appears once this account has two daily snapshots — we take one a day, and this one is on its first.
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Frequently asked questions about @zalaly
How many followers does @zalaly have?
31 805 followers.
How many posts has @zalaly published?
3 369 posts.
How do posts by @zalaly perform?
Collected posts: 25. Views: 444 810. Likes: 2 130.