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Specific cardiac considerations include: Heart rhythm concerns: The heart rate-increasing effect may require additional monitoring in patients with atrial fibrillation, supraventricular tachycardia, or ventricular arrhythmias Heart failure: Patients with New York Heart Association (NYHA) Class III-IV heart failure were excluded from major clinical trials, and there is limited safety data in this population [18] [21] Recent cardiac events: Patients with recent myocardial infarction, stroke, or unstable angina may require individualized assessment during the recovery period Hemodynamic considerations: Rapid weight loss may affect fluid balance in patients with significant cardiac disease Adverse effects relevant to cardiac patients include gastrointestinal symptoms (nausea, vomiting, diarrhea) that may lead to dehydration and electrolyte disturbances

174 Pancreatic cancer cells overexpress the bicarbonate transporter SLC4A4, promoting TME acidification, lactate secretion, and immunosuppression

The same manufacturer, Novo Nordisk, has another weight loss drug called Wegovy with the same active ingredient (semaglutide) that is FDA-approved for weight loss and some plans may only provide coverage for Wegovy if prescribed for weight loss and might only provide coverage for Ozempic if prescribed for diabetes

The genetic test reveals predispositions in peptide and metabolic pathwaysnot exact medication response or thyroid status