{ "release_id": "f6f6f1b6f50379ed", "id": "cardio:glp1-receptor-agonists", "owner": "cardio", "kind": "drug", "slug": "glp1-receptor-agonists", "name": "GLP-1 receptor agonists (drug class)", "aliases": [ "GLP-1 receptor agonists", "GLP-1 RAs", "Glucagon-like peptide-1 receptor agonists" ], "atlases": [ "cardio" ], "summary_plain": "A group of diabetes medicines called GLP-1 receptor agonists. Some are given as a weekly injection. Large trials in people with type 2 diabetes asked whether they lower the chance of heart attack, stroke and heart-related death, and one trial asked the same question in people who had heart disease and obesity but no diabetes.", "summary_technical": "Class record joining the cardiovascular outcome trials of GLP-1 receptor agonists. A 2018 meta-analysis of ELIXA, LEADER, SUSTAIN 6 and EXSCEL found a 10 percent lower risk of three-point major adverse cardiovascular events (hazard ratio 0.90, 95% CI 0.82 to 0.99). Semaglutide and tirzepatide are members by the established pharmacologic class listed in RxClass. SELECT tested semaglutide in people without diabetes; SURPASS-CVOT compared tirzepatide with dulaglutide.", "editorial_state": "draft", "last_substantive_edit": "2026-10-15", "last_evidence_check": null, "next_review_due": null, "identifiers": [ { "scheme": "mesh", "value": "D000097789", "normalized_value": "D000097789", "match": "exact", "version": "2026", "label": null, "from_source": false } ], "navigation": { "cardio": { "system": [ "metabolism" ], "condition-area": [ "diabetes-and-metabolic-disease" ] } }, "payload": { "level": "class", "mechanism": null }, "content_digest": "c6139e90658c3311cb956a682c94d1c12c58bf38b0ccfeaa834de4782a902461", "review": { "content_digest": "c6139e90658c3311cb956a682c94d1c12c58bf38b0ccfeaa834de4782a902461", "current": [], "conflicting": [], "stale": [], "inactive": [] }, "claims": [ { "release_id": "f6f6f1b6f50379ed", "id": "cardio:claim-glp1-ra-meta-analysis-mace", "owner": "cardio", "subject_entity_id": "cardio:glp1-receptor-agonists", "category": "effect", "statement": "A 2018 meta-analysis pooled four cardiovascular outcome trials of GLP-1 receptor agonists in adults with type 2 diabetes: ELIXA (lixisenatide), LEADER (liraglutide), SUSTAIN 6 (semaglutide) and EXSCEL (extended-release exenatide). Compared with placebo, the drugs lowered the risk of the three-point major adverse cardiovascular event outcome (cardiovascular death, nonfatal heart attack or nonfatal stroke) by 10 percent (hazard ratio 0.90, 95% CI 0.82 to 0.99; p=0.033). Cardiovascular death was 13 percent lower (0.87, 0.79 to 0.96) and death from any cause 12 percent lower (0.88, 0.81 to 0.95). The authors found no significant effect on fatal and non-fatal heart attack, fatal and non-fatal stroke, hospital admission for unstable angina, or hospital admission for heart failure. They also found no significant differences in severe hypoglycaemia, pancreatitis, pancreatic cancer or medullary thyroid cancer.", "context": { "id": "cardio:ctx-glp1-ra-cvot-adults-with-type-2-diabetes", "label": "Adults with type 2 diabetes in four GLP-1 receptor agonist cardiovascular outcome trials (ELIXA, LEADER, SUSTAIN 6, EXSCEL)", "recipient": "adult", "population": "Adults aged 18 years or older with type 2 diabetes, in randomized trials that compared a GLP-1 receptor agonist with placebo and had a primary outcome that included cardiovascular death, nonfatal myocardial infarction and nonfatal stroke.", "care_setting": "Not stated in the abstract", "geography": "Not stated in the abstract", "life_stage_note": "Adults aged 18 years or older", "life_stage_terms": null, "gestational_age_min_days": null, "gestational_age_max_days": null, "gestational_age_basis": null, "postnatal_age_min_days": null, "postnatal_age_max_days": null, "gestational_age_status": null, "postnatal_age_status": null, "followup_description": "Not stated for the pooled analysis. The literature search ran up to 18 September 2017.", "eligibility": { "inclusion": [ "Adult patients (18 years or older) with type 2 diabetes", "Randomized comparison of a GLP-1 receptor agonist with placebo", "Primary outcome including, but not limited to, cardiovascular mortality, nonfatal myocardial infarction and nonfatal stroke" ], "exclusion": [] } }, "evidence_stage": "synthesis", "certainty": "not_assessed", "certainty_method": null, "limitations": "A pooled analysis of published trials of four different drugs, not of one drug. The abstract says the benefit varied to varying degrees between individual drugs and that between-trial heterogeneity was low to moderate. The search ran only up to 18 September 2017, so later trials, such as SELECT and SURPASS-CVOT in this atlas, are not in it. The abstract names the funding as Amylin Pharmaceuticals (AstraZeneca). The abstract does not grade certainty. Only the PubMed abstract was read.", "editorial_state": "draft", "checked_at": "2026-10-14", "next_review_due": null, "valid_from": null, "valid_to": null, "citations": [ { "evidence_role": "supports", "locator": "Abstract, FINDINGS, sentence 1", "applicability_note": "The four trials the meta-analysis found.", "snapshot": { "id": "cardio:pubmed-29221659-2026-10-14", "retrieved_at": "2026-10-14T18:18:50Z", "content_hash": "dcf556409b960c64a25ada11dce3bb914295a33577ab5cd400516c6b2657fc85", "source_effective_date": null, "public_archive_url": null, "source_state": "current" }, "source": { "id": "cardio:pubmed-10-1016-s2213-8587-17-30412-6", "source_type": "publication", "title": "Cardiovascular outcomes with glucagon-like peptide-1 receptor agonists in patients with type 2 diabetes: a meta-analysis", "canonical_url": "https://doi.org/10.1016/S2213-8587(17)30412-6", "identifiers": [ { "scheme": "doi", "value": "10.1016/S2213-8587(17)30412-6", "normalized_value": "10.1016/s2213-8587(17)30412-6", "match": "exact", "version": null, "label": null, "from_source": false }, { "scheme": "pmid", "value": "29221659", "normalized_value": "29221659", "match": "exact", "version": null, "label": null, "from_source": false } ], "publication_date": "2017-12-06", "publisher": "The lancet. 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