Addiction as a cardiometabolic disease: a neurocardiometabolic framework and the emerging role of GLP-1 receptor therapies

Substance-use disorders are major accelerators of cardiometabolic disease, yet this dimension remains insufficiently recognized within addiction care. Individuals with substance-use disorders frequently exhibit hypertension, adverse lipid profiles, visceral adiposity, metabolic syndrome, chronic low-grade inflammation and autonomic imbalance, contributing to markedly elevated cardiovascular morbidity and premature mortality. The recent European Society of Cardiology Clinical Consensus Statement on mental health and cardiovascular disease highlights this gap and calls for structured cardiometabolic assessment and prevention strategies within behavioural and psychiatric population. Glucagon-like peptide-1 receptor therapies have emerged as multisystem agents relevant to both addictive behaviour and cardiometabolic health. Experimental and early clinical evidence demonstrates reductions in craving, improved reward regulation and attenuation of impulsive consumption across alcohol, nicotine, stimulant use and binge-type eating, mediated through gut-brain communication, mesolimbic dopamine circuitry, hypothalamic pathways and stress-responsive networks. In parallel, these therapies induce clinically meaningful reductions in body weight, visceral adiposity, blood pressure and inflammatory burden, while improving glucose regulation and cardiometabolic markers. Large cardiovascular outcome trials demonstrate reductions in major adverse cardiovascular events in high-risk populations, and emerging primary-prevention analyses report favourable changes in estimated cardiovascular risk even without established cardiovascular disease. This review integrates biological, clinical and real-world evidence to propose a unified neurocardiometabolic framework in which glucagon-like peptide-1 receptor therapies may simultaneously influence addictive behaviour and long-term cardiovascular risk trajectories. We outline mechanistic foundations and potential clinical applications within detoxification programmes, relapse-prevention settings, dual-diagnosis services and addiction care, while highlighting the need for further clinical validation before routine implementation.