CirculationDec 12, 2022

GLP-1 Drugs and Lower Heart Disease Risk in People with Type 2 Diabetes

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

Updated Mar 29, 2026

Abstract

Patients with type 2 diabetes have a high risk of cardiovascular disease, which can be significantly reduced by SGLT2 inhibitors and GLP-1 receptor agonists.

Robust reductions in major adverse cardiovascular events have been observed in patients with type 2 diabetes using SGLT2 inhibitors and GLP-1 receptor agonists.
Hospitalizations for heart failure are significantly reduced with these glucose-lowering agents.
Current diabetes and cardiology guidelines strongly recommend the use of SGLT2 inhibitors and GLP-1 receptor agonists for high-risk individuals, regardless of glucose control needs.
Activation of the GLP-1 receptor leads to improved blood glucose levels and enhances feelings of fullness, contributing to weight loss.
Cardiovascular outcome trials show consistent reductions in atherothrombotic events, especially in patients with existing atherosclerotic cardiovascular disease.
Despite clear evidence of cardiovascular benefits, the usage rates of these medications among eligible patients remain low.

Simplified

Patients with type 2 diabetes are at high risk for development of cardiovascular disease, including myocardial infarction, stroke, heart failure, and cardiovascular death. Multiple large cardiovascular outcome trials with novel glucose-lowering agents, namely SGLT2i (SGLT2 inhibitors) and GLP-1 RA (GLP-1 receptor agonists), have demonstrated robust and significant reductions of major adverse cardiovascular events and additional cardiovascular outcomes, such as hospitalizations for heart failure. This evidence has changed the landscape for treatment of patients with type 2 diabetes. Both diabetes and cardiology guidelines and professional societies have responded to this paradigm shift by including strong recommendations to use SGLT2i and/or GLP-1 RA, with evidence-based benefits to reduce cardiovascular risk in high-risk individuals with type 2 diabetes, independent of the need for additional glucose control. GLP-1 RA were initially developed as glucose-lowering drugs because activation of the GLP-1 receptor by these agents leads to a reduction in blood glucose and an improvement in postprandial glucose metabolism. By stimulating GLP-1R in hypothalamic neurons, GLP-1 RA additionally induce satiety and lead to weight loss. Data from cardiovascular outcome trials demonstrated a robust and consistent reduction in atherothrombotic events, particularly in patients with established atherosclerotic cardiovascular disease. Despite the consistent evidence of atherosclerotic cardiovascular disease benefit from these trials, the number of patients receiving these drugs remains low. This overview summarizes the experimental and clinical evidence of cardiovascular risk reduction offered by GLP-1 RA, and provides practical information on how these drugs should be implemented in the treatment of type 2 diabetes in the cardiology community.

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GLP-1 Drugs and Lower Heart Disease Risk in People with Type 2 Diabetes

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