Abstract
This systematic review evaluates the cardiovascular effects of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) in adults with type 2 diabetes mellitus (T2DM) and established atherosclerotic cardiovascular disease, chronic kidney disease, or heart failure (HF). A comprehensive literature search across four major databases identified eight eligible studies, including randomized controlled trials and prespecified or pooled post-hoc analyses. The findings demonstrate consistent cardiovascular benefits of GLP-1 RAs, particularly semaglutide and exenatide, with notable reductions in major adverse cardiovascular events, cardiovascular mortality, and HF-related outcomes. Mechanistically, these benefits may be attributed to anti-inflammatory effects, improved endothelial function, and metabolic improvements such as weight loss and blood pressure reduction. Despite some heterogeneity across subgroups and study designs, the overall evidence supports the integration of GLP-1 RAs into cardiovascular risk management for patients with T2DM.