GLP ‐1 receptor agonists and cardiovascular outcomes in Asian, Black or African American, and White populations: An updated meta‐analysis including the SOUL trial

Abstract Aims To evaluate the cardiovascular efficacy of glucagon‐like peptide‐1 receptor agonists (GLP‐1RAs) in Asian, Black or African American, and White populations, and to assess whether the magnitude of cardiovascular risk reduction differs across these populations. Materials and Methods PubMed and EMBASE were searched to 11 November 2025 for randomized placebo‐controlled GLP‐1RA trials in adults with type 2 diabetes or overweight/obesity that reported race‐stratified major adverse cardiovascular events (MACE; cardiovascular death, non‐fatal myocardial infarction, or non‐fatal stroke). Hazard ratios (HRs) for MACE were extracted for Asian, Black or African American, and White populations. Random‐effects meta‐analyses were used to obtain pooled HRs and ratios of HRs (RHRs) comparing treatment effects between populations. Results Nine trials, including the recent SOUL trial, were included, comprising 8164 Asian, 4036 Black or African American, and 62 503 White participants. GLP‐1RAs reduced MACE risk in Asian (HR 0.73; 95% CI 0.63–0.85; p < 0.001) and White populations (HR 0.86; 95% CI 0.81–0.91; p < 0.001). In Black or African American populations, the effect was similar to that in White populations (HR 0.88; 95% CI 0.67–1.15; p = 0.34) but did not reach statistical significance. The pooled RHR for Asian versus White populations was 0.84 (95% CI 0.71–0.98; p = 0.027), indicating a significantly greater risk reduction in Asian populations. The RHR for Asian versus Black or African American populations was 0.81 (95% CI 0.57–1.16; p = 0.25), with point estimates favouring Asian populations. Conclusions GLP‐1RAs reduced MACE risk across populations, with greater relative risk reduction in Asian populations and broadly similar benefits in Black or African American and White populations.