GLP-1 receptor agonists reduced the risk of MACE and MI in people with overweight and obesity across 5 high-certainty meta-analyses, driven by patients with established cardiovascular disease.
Systematic Review
Do GLP-1-based medicines improve cardiovascular outcomes in people with overweight and obesity?
GLP-1 RAs reduce MACE and MI in overweight/obese patients, but this benefit appears limited to those with established cardiovascular disease at baseline.
INTRODUCTION: Cardiovascular (CV) outcomes of Glucagon-like peptide-1 (GLP-1)-based medicines among people with overweight and obese (OW/OB) population have been investigated by meta-analyses of randomized controlled trials (RCTs), but an overall summary is lacking. METHODS: PubMed, EMBASE, Epistemonikos, and Cochrane databases were searched till May 2024 for meta-analyses of RCTs that assessed CV outcomes of GLP-1-based medicines among people with OW/OB. GRADE approach was used to assess strength of associations. RESULTS: Nine studies with 58 unique meta-analyses were included. Fifteen (25.9%) associations were statistically significant. Five high certainty evidence demonstrated beneficial effects of GLP-1 RAs on any CV events (N= 1), major adverse cardiac events (MACE) (N = 2), and myocardial infarction (MI) (N = 2), whereas two associations on revascularization (N = 1) and CV events (N = 1) were supported by moderate certainty. Four associations demonstrated inverse effects of tirzepatide on MACE (N = 1; moderate) and hypertension (N = 3; low). Remaining four demonstrated higher risk of arrhythmia with GLP-1 RAs (N = 1; moderate) and increased heart rate with tirzepatide (N = 3; low to moderate). Although the inverse association between GLP-1 RAs and MACE and MI was significant and supported by high certainty evidence in both main and sensitivity analyses, these associations were no longer statistically significant among patients without CV disease (CVD) at baseline. CONCLUSION: Findings suggest that GLP-1 RAs are associated with reduced risk of MACE, and MI among people with OW/OB, but they were driven by studies with established CVD at baseline.
Rashid et al. (Wed,) conducted a systematic review in Overweight and obesity. GLP-1-based medicines was evaluated on Cardiovascular outcomes (including MACE and MI). GLP-1 receptor agonists reduced the risk of MACE and MI in people with overweight and obesity across 5 high-certainty meta-analyses, driven by patients with established cardiovascular disease.