On the front lines of cardiovascular-kidney-metabolic syndrome: Review of GLP-1 and Dual GLP-1/GIP receptor agonists in CV and kidney health

📖 Top 50% JournalApr 8, 2025American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists

GLP-1 and Dual GLP-1/GIP Treatments and Their Role in Heart, Kidney, and Metabolic Health

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Abstract

GLP-1 receptor agonists may reduce cardiovascular events and preserve kidney function in patients with cardiovascular disease.

Significant benefits of GLP-1 receptor agonists in reducing cardiovascular events have been observed in patients with preexisting cardiovascular disease.
These agents are associated with kidney function preservation in individuals at high cardiovascular risk.
Current guidelines highlight the potential of GLP-1 receptor agonists for managing chronic kidney disease, type 2 diabetes, and metabolic syndrome.
Emerging data suggests their effectiveness may extend beyond type 2 diabetes management.
Pharmacists are crucial in recommending these treatments and addressing barriers to care for high-risk patients.

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PURPOSE: The purpose of this review is to highlight the role of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and dual GLP-1/glucose-dependent insulinotropic polypeptide (GIP) receptor agonists (GLP-1/GIP RAs) in managing cardiovascular-kidney-metabolic (CKM) syndrome, focusing on their cardiovascular (CV) and kidney-protective effects beyond glycemic control.

SUMMARY: In multiple randomized controlled trials, GLP-1 RAs were demonstrated to confer significant benefits in reducing CV events and preserving kidney function in patients with preexisting atherosclerotic cardiovascular disease (ASCVD) and those at high CV risk. Current guidelines, including those from the Kidney Disease: Improving Global Outcomes (KDIGO) initiative and the American Diabetes Association (ADA), underscore the therapeutic potential of these agents for managing chronic kidney disease (CKD), type 2 diabetes mellitus (T2DM), and metabolic syndrome. Additionally, emerging data suggests their utility beyond T2DM. This review summarizes the evidence supporting these guidelines, along with newer findings not yet fully integrated into clinical practice. It also examines the role of pharmacists and multidisciplinary teams, safety considerations, and practical strategies for managing common adverse effects.

CONCLUSION: The integration of GLP-1 RAs and dual GLP-1/GIP RAs into clinical practice offers substantial benefits for patients, both with and without diabetes. Pharmacists play a pivotal role in recommending evidence-based treatments for those at high CV and kidney risk, educating patients, addressing social determinants of health, and bridging gaps across multidisciplinary care teams.

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