Cardiometabolic effects of GLP-1 analogs in obese and overweight patients with preexisting cardiovascular disease: A systematic review and meta analysis of randomized controlled trials

Background: Obesity is escalating global concerns, strongly associated with cardiovascular (CV) diseases. Lifestyle interventions often prove insufficient, driving interest in new treatments like GLP-1 analogs (GLP1a). Objectives: This study assesses the efficacy of GLP1a in patients with obesity and pre-existing CV disease. Methods: A systematic search in PubMed, Scopus, and Cochrane databases identified randomized controlled trials comparing GLP1a with placebo for CV risk reduction. Statistical analyses were conducted using Review Manager 5.4.1, employing a random-effects model for outcomes with high heterogeneity. RoB 2 was used to assess the risk of bias. Results: Four RCTs with 19,480 patients were included, 9740 of whom received GLP1a. The GLP1a group showed reduced all-cause mortality (OR, 0.82; 95 % CI, 0.72–0.94; p = 0.004) and waist circumference (MD, -7.02; 95 % CI, -8.31–-5.84; p < 0.00001). Significant decreases were also observed in systolic blood pressure (MD, -3.32; 95 % CI, -3.76–-2.89; p < 0.00001), serious adverse events (OR, 0.7; 95 % CI, 0.5–0.99; p = 0.04), and hospitalization for heart failure (OR, 0.47; 95 % CI, 0.25–0.89; p = 0.02). C-reactive protein (CRP) level levels were significantly lower (MD, -36.92; 95 % CI, -39.56–-34.27; p < 0.00001). However, no significant difference was observed for CV-related mortality (OR, 0.85; 95 % CI, 0.71–1.02; p = 0.08). Conclusions: GLP1a reduces all-cause mortality, waist circumference, systolic blood pressure and CRP levels, highlighting its therapeutic potential for CV disease.