PharmacotherapyOct 22, 2022

GLP-1 receptor drugs and heart health in people with type 2 diabetes and kidney disease: A review and combined analysis

GLP-1 Therapies Weekly Brief ↗PubMed ↗DOI ↗OA ↗

Updated Feb 15, 2026

Abstract

A total of 7130 patients were analyzed to evaluate cardiovascular outcomes of glucagon-like peptide-1 receptor agonists in those with type 2 diabetes and chronic kidney disease.

No significant reduction was observed in composite cardiovascular outcomes among patients with type 2 diabetes and chronic kidney disease receiving glucagon-like peptide-1 receptor agonists.
The odds ratio for the composite cardiovascular endpoint was 0.80, with a 95% confidence interval of 0.59-1.07, indicating no strong evidence for benefit.
Individual components of cardiovascular outcomes did not show evidence of a reduction associated with glucagon-like peptide-1 receptor agonists.
The findings suggest that while some glucagon-like peptide-1 receptor agonists may provide cardiovascular benefits, this is not consistent across all medications in this class.
Patients with chronic kidney disease and type 2 diabetes are advised to use glucagon-like peptide-1 receptor agonists with proven cardiovascular benefits to reduce risk.

Simplified

AIM: To evaluate the cardiovascular outcomes of glucagon-like peptide-1 receptor agonists (GLP1-RA) in patients with type 2 diabetes (T2DM) and chronic kidney disease (CKD).

MATERIALS AND METHODS: We searched PubMed, Ovid MEDLINE, CINAHL, and Web of Science databases for randomized controlled trials reporting event rates for a composite cardiovascular outcome of cardiovascular death, myocardial infarction, and stroke in patients with T2DM and CKD receiving GLP1-RA or placebo. Studies were restricted to those reporting specific event rates for patients with CKD separately from the overall population. We conducted a meta-analysis using a random-effects model. This meta-analysis was registered on PROSPERO (CRD42022320157).

RESULTS: A total of four studies comprising 7130 patients was included in our analysis. Four different GLP1-RA were assessed in a population with CKD defined as estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m. Treatment with GLP1-RA was not associated with a significant reduction in the composite cardiovascular end point of cardiovascular death, nonfatal myocardial infarction, and nonfatal stroke (odds ratio (OR) 0.80; 95% confidence interval (CI), 0.59-1.07; p = 0.13) among patients with T2DM and CKD. Individual components of the composite cardiovascular end point were assessed in two trials and did not show evidence of an effect of GLP1-RA in reducing cardiovascular end points. 2

CONCLUSIONS: Pooled analysis of clinical trials reporting separate cardiovascular events rates in patients with T2DM and CKD did not find GLP1-RA to be associated with a reduction in composite cardiovascular event rates. Select GLP1-RA may offer cardiovascular event reduction in patients with T2DM and CKD, but this does not appear to be a class effect. Use of GLP1-RA with demonstrated cardiovascular benefits should be preferred in patients with CKD and T2DM to further reduce cardiovascular risk.

Key numbers

0.80

Odds Ratio for Composite Cardiovascular Outcome

Odds ratio comparing GLP1-RA to placebo in patients with CKD

7130

Number of Patients Analyzed

Total number of patients with CKD included in the meta-analysis

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Funding

Competing interests

The authors declare no conflicts of interest.

PubMed

GLP-1 receptor drugs and heart health in people with type 2 diabetes and kidney disease: A review and combined analysis

Abstract

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