# Does Ozempic Lower Cholesterol? What the Lipid Results in the Trials Show

Does Ozempic lower cholesterol? A little: LDL fell 2.5% vs a 1.3% rise on placebo in STEP 1 | triglycerides fell 21.9%, and tirzepatide moved lipids further.

Publisher: This GLP Editorial Team
Canonical: https://thisglp.com/research/does-ozempic-lower-cholesterol
Updated: 2026-09-18
Published: 2026-09-18

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Evidence

# Does Ozempic Lower Cholesterol? What the Lipid Results in the Trials Show

A little. On semaglutide 2.4 mg, LDL fell 2.5% from 110.3 mg/dL against a 1.3% rise on placebo, while triglycerides fell 21.9%. In type 2 diabetes the LDL effect was 0.16 mmol/L.

[This GLP Editorial Team](https://thisglp.com/about)September 20267 min read

STEP 1, semaglutide 2.4 mg vs placebo, % change at 68 weeks · LDL cholesterol · −2.5% vs +1.3% · Total cholesterol · −3.3% vs +0.1% · HDL cholesterol · +5.2% vs +1.4% · Triglycerides · −21.9% vs −7.3% · Wegovy label, Table 13. Adults without diabetes. Ozempic doses are lower.

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A little, and triglycerides fall much more than LDL. In the 68-week STEP 1 trial of semaglutide 2.4 mg, LDL cholesterol fell 2.5 percent from an average of 110.3 mg/dL, roughly 3 mg/dL [\[1\]](https://thisglp.com/research/does-ozempic-lower-cholesterol#ref-1) [\[2\]](https://thisglp.com/research/does-ozempic-lower-cholesterol#ref-2). On placebo it rose 1.3 percent. Triglycerides fell 21.9 percent against 7.3 percent. At the lower Ozempic doses, a network meta-analysis of 76 diabetes trials put the LDL reduction at 0.16 mmol/L [\[3\]](https://thisglp.com/research/does-ozempic-lower-cholesterol#ref-3).

## Key takeaways

-   In STEP 1 (1,961 adults without diabetes, semaglutide 2.4 mg, 68 weeks), LDL changed −2.5% against +1.3% on placebo, from a baseline of 110.3 mg/dL.
-   Triglycerides moved most: −21.9% against −7.3%. HDL rose 5.2% against 1.4%.
-   Pooling four 2.4 mg trials, LDL fell by a mean 6.01 mg/dL and triglycerides by 14.75 mg/dL against placebo.
-   In type 2 diabetes, across 76 trials, semaglutide lowered LDL by 0.16 mmol/L and total cholesterol by 0.48 mmol/L.
-   Tirzepatide (Zepbound) lowered LDL 4.6% to 7.1% against 1.7% on placebo, and triglycerides 21.2% to 29.1%.

Two cautions apply to every number below. First, the Ozempic label itself prints no cholesterol table; the trial percentages come from Wegovy, the 2.4 mg dose of the same drug. Second, lipids were secondary measures in these trials. How the two drugs compare on weight, the primary outcome, is in [tirzepatide against semaglutide](https://thisglp.com/research/tirzepatide-vs-semaglutide-which-works-better).

## What STEP 1 measured on cholesterol

STEP 1 randomized 1,961 adults with obesity or overweight and no diabetes, 2:1, to semaglutide 2.4 mg or placebo for 68 weeks [\[2\]](https://thisglp.com/research/does-ozempic-lower-cholesterol#ref-2). The label reports the lipid results as percent change from baseline [\[1\]](https://thisglp.com/research/does-ozempic-lower-cholesterol#ref-1):

1.  Total cholesterol: −3.3 percent against +0.1 percent, from 189.6 mg/dL.
2.  LDL cholesterol: −2.5 percent against +1.3 percent, a relative difference of −3.8 percent.
3.  HDL cholesterol: +5.2 percent against +1.4 percent.
4.  Triglycerides: −21.9 percent against −7.3 percent, from 126.2 mg/dL.

The label notes that these measures were not part of the pre-specified testing order. The LDL change is small next to the triglyceride change. A pooled analysis of four 2.4 mg trials of at least 68 weeks gives the same shape in mg/dL [\[4\]](https://thisglp.com/research/does-ozempic-lower-cholesterol#ref-4). LDL fell by a mean 6.01 mg/dL, total cholesterol by 6.39 mg/dL and triglycerides by 14.75 mg/dL. HDL rose by 1.82 mg/dL.

## Does Ozempic lower cholesterol in type 2 diabetes?

Ozempic is approved for type 2 diabetes at 0.5 to 2 mg. The best estimate for that population is a network meta-analysis of 76 trials, 15 GLP-1 drugs and 39,246 adults [\[3\]](https://thisglp.com/research/does-ozempic-lower-cholesterol#ref-3). Against placebo, the mean difference for semaglutide was −0.16 mmol/L for LDL (95% CI −0.30 to −0.02). For total cholesterol it was −0.48 mmol/L (95% CI −0.84 to −0.11). The LDL interval ends just short of zero.

One trial in the Wegovy label shows the limit directly. In STEP 2, adults with type 2 diabetes on 2.4 mg saw LDL change by +0.5 percent against +0.1 percent on placebo [\[1\]](https://thisglp.com/research/does-ozempic-lower-cholesterol#ref-1). Triglycerides still fell, by 22 percent against 9.4 percent. In that trial, the triglyceride effect held and the LDL effect did not appear.

Where the evidence stops

None of these trials was designed to treat high cholesterol, and none tested semaglutide against a statin. Lipids were secondary or exploratory measures. The figures come from branded semaglutide; compounded semaglutide is not FDA-approved and has no trial lipid data.

## Does Zepbound lower cholesterol?

Tirzepatide moved lipids further in its obesity trial. The Zepbound label reports 72-week results from SURMOUNT-1 by dose [\[5\]](https://thisglp.com/research/does-ozempic-lower-cholesterol#ref-5). LDL fell 4.6, 5.6 and 7.1 percent on 5, 10 and 15 mg, against 1.7 percent on placebo, from about 109 mg/dL. The relative difference at 5 mg had a confidence interval crossing zero. Triglycerides fell 21.2 to 29.1 percent against 5.6 percent, and HDL rose 6.9 to 9.2 percent.

A meta-analysis of seven randomized trials found the same pattern with dose [\[6\]](https://thisglp.com/research/does-ozempic-lower-cholesterol#ref-6). Total cholesterol fell 3.76 percent on 5 mg, 4.63 percent on 10 mg and 5.93 percent on 15 mg. LDL and triglycerides fell and HDL rose. How much of this follows weight loss rather than the drug itself was not separated in these abstracts. A SURMOUNT-1 analysis of uric acid faced the same question, set out in [the uric acid log entry](https://thisglp.com/research/uric-acid-fell-and-most-of-it-was-weight).

## Cholesterol medicines and heart risk

One pooled analysis looked at lipid-lowering prescriptions across five STEP trials [\[7\]](https://thisglp.com/research/does-ozempic-lower-cholesterol#ref-7). More people on semaglutide had their lipid-lowering treatment reduced, and fewer had it intensified, than on placebo. The abstract gives no counts. It is a post hoc analysis, and several authors are Novo Nordisk employees.

In SELECT, 17,604 adults with established cardiovascular disease and no diabetes took semaglutide 2.4 mg or placebo [\[1\]](https://thisglp.com/research/does-ozempic-lower-cholesterol#ref-1). At baseline, 90 percent were on lipid-lowering therapy. At week 104, LDL changed −5.3 percent against −3.1 percent, from 78.5 mg/dL. The trial was built to measure a composite of cardiovascular death, heart attack and stroke, and the cholesterol change beside it was small. What drove the benefit is covered in [whether GLP-1 drugs prevent heart attacks and strokes](https://thisglp.com/research/do-glp1-drugs-prevent-heart-attacks-and-strokes) and in [the inflammation evidence](https://thisglp.com/research/do-glp1-drugs-reduce-inflammation).

## Frequently asked

Does semaglutide lower cholesterol?

Modestly. In STEP 1, semaglutide 2.4 mg changed LDL by −2.5% against +1.3% on placebo over 68 weeks, and triglycerides by −21.9% against −7.3%. Across 76 type 2 diabetes trials, semaglutide lowered LDL by 0.16 mmol/L.

Does Zepbound lower cholesterol?

Yes, somewhat more than semaglutide did in its own trials. In SURMOUNT-1, LDL fell 4.6% to 7.1% across doses against 1.7% on placebo, and triglycerides fell 21.2% to 29.1% against 5.6%.

Does tirzepatide lower cholesterol in a dose-dependent way?

A meta-analysis of seven trials found total cholesterol fell 3.76% on 5 mg, 4.63% on 10 mg and 5.93% on 15 mg. The two drugs have not been compared head to head on lipids.

Can a GLP-1 replace a cholesterol medicine?

No trial has tested that. The LDL changes on semaglutide were a few percent, and no study compared a GLP-1 with a statin. A post hoc STEP analysis found lipid-lowering treatment was reduced more often on semaglutide, without giving counts.

## Sources

1.  \[1\] Novo Nordisk (2026). WEGOVY (semaglutide) injection, for subcutaneous use — prescribing information, Tables 7 and 13 DailyMed, U.S. National Library of Medicine. [Source](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=ee06186f-2aa3-4990-a760-757579d8f77b)
2.  \[2\] Wilding JPH, Batterham RL, Calanna S, et al. (2021). Once-Weekly Semaglutide in Adults with Overweight or Obesity The New England Journal of Medicine. [PMID 33567185](https://pubmed.ncbi.nlm.nih.gov/33567185/)
3.  \[3\] Yao H, Zhang A, Li D, Wu Y, Wang CZ, Wan JY, Yuan CS (2024). Comparative effectiveness of GLP-1 receptor agonists on glycaemic control, body weight, and lipid profile for type 2 diabetes: systematic review and network meta-analysis BMJ. [PMID 38286487](https://pubmed.ncbi.nlm.nih.gov/38286487/)
4.  \[4\] Miranda S, Choudhari J, Chauhan N, Parmar MS (2025). Impact of semaglutide on lipid profiles in overweight and obese non-diabetic adults: A systematic review and meta-analysis of randomized controlled trials European Journal of Pharmacology. [PMID 40675357](https://pubmed.ncbi.nlm.nih.gov/40675357/)
5.  \[5\] Eli Lilly and Company (2026). ZEPBOUND (tirzepatide) injection, for subcutaneous use — prescribing information, Table 3 DailyMed, U.S. National Library of Medicine. [Source](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=487cd7e7-434c-4925-99fa-aa80b1cc776b)
6.  \[6\] Kanbay M, Copur S, Siriopol D, Yildiz AB, Gaipov A, van Raalte DH, Tuttle KR (2023). Effect of tirzepatide on blood pressure and lipids: A meta-analysis of randomized controlled trials Diabetes, Obesity & Metabolism. [PMID 37700437](https://pubmed.ncbi.nlm.nih.gov/37700437/)
7.  \[7\] Tchang BG, Knight MG, Adelborg K, Clements JN, Iversen AT, Traina A (2025). Effect of semaglutide 2.4 mg on use of antihypertensive and lipid-lowering treatment in five randomized controlled STEP trials Obesity (Silver Spring). [PMID 39756397](https://pubmed.ncbi.nlm.nih.gov/39756397/)

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