Abstract Background Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have emerged as a foundational therapeutic option for type 2 diabetes mellitus (T2DM), offering glycemic control and cardiovascular benefits. This systematic review and meta-analysis evaluates the impact of GLP-1RAs on cardiovascular outcomes in patients with T2DM. Methods We conducted a comprehensive search of PubMed, Embase, and Cochrane Library up to March 31, 2025, for randomized controlled trials (RCTs) comparing GLP-1RAs with placebo in T2DM patients. Risk ratios (RR) with 95% confidence intervals (CIs) were pooled using a random-effects model. Results Twenty RCTs involving 83,004 patients were included. GLP-1RAs significantly reduced the risk of major adverse cardiovascular events (RR 0.87, 95% CI 0.83–0.92), all-cause death (RR 0.89, 95% CI 0.84–0.93), cardiovascular death (RR 0.88, 95% CI 0.81–0.94), myocardial infarction (RR 0.87, 95% CI 0.79–0.96), stroke (RR 0.88, 95% CI 0.81–0.96) and composite renal outcome (RR 0.80, 95% CI 0.73–0.88) compared to placebo. In addition, a trend of reduction in heart failure hospitalizations (RR 0.93, 95% CI 0.85–1.01), and coronary revascularization (RR = 0.87, 95% CI 0.74 to 1.01) was observed with GLP-1 RAs without reaching statistical significance. Conclusion GLP-1RAs are associated with improved cardiovascular outcomes in patients with T2DM. These findings support current guideline recommendations and highlight their cardioprotective benefits beyond glycemic control in patients with T2DM.
Ahmed et al. (2026) studied this question.