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GLP-1 Receptor Agonists and Cardiovascular and Kidney Outcomes by Body Mass Index in Type 2 Diabetes

Prerana Ramadurgum1, Kunal Sharma2, Alec Pinon2

  • 1Department of Internal Medicine, Texas Tech University Health Sciences Center, El Paso, TX, 75505, USA. prerana.ramadurgum@gmail.com.

Current Cardiology Reports
|March 25, 2026
PubMed
Abstract

Insights

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) offer significant cardiovascular and kidney protection for type 2 diabetes patients, regardless of body mass index (BMI). Cardiovascular benefits may be greater in those with higher BMI, while kidney protection is consistent across all BMI categories.

Area of Science:

  • Cardiology
  • Nephrology
  • Endocrinology
  • Metabolic Diseases

Background:

  • Type 2 diabetes (T2DM) is associated with increased cardiovascular and kidney disease risk.
  • Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are increasingly used for glycemic control and cardiorenal risk reduction in T2DM.
  • The influence of body mass index (BMI) on the efficacy of GLP-1 RAs for cardiorenal outcomes is not fully understood.

Purpose of the Study:

  • To investigate whether body mass index (BMI) influences the cardiovascular and kidney outcomes of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) in patients with type 2 diabetes (T2DM).
  • To explore how metabolic phenotype may impact treatment response to GLP-1 RAs regarding cardiorenal protection.

Main Methods:

  • Systematic review and meta-analysis of randomized controlled trials involving GLP-1 RAs.
  • Analysis of observational studies to assess cardiovascular risk reduction across different BMI categories.
  • Evaluation of renal outcomes, including kidney function decline and albuminuria, stratified by BMI.

Main Results:

  • GLP-1 RAs demonstrated consistent cardiovascular event reduction across diverse populations, with no significant heterogeneity based on BMI.
  • Observational data suggest potentially greater absolute cardiovascular risk reduction in individuals with overweight or obesity.
  • Renal benefits, including slower kidney function decline and reduced albuminuria, were uniform across all BMI categories, indicating BMI-independent nephroprotection.

Conclusions:

  • GLP-1 RAs provide significant and clinically meaningful cardiorenal protection across the entire BMI spectrum in patients with T2DM.
  • Cardiovascular benefits may be more pronounced in individuals with higher BMI, while renal protection remains consistent irrespective of adiposity.
  • These findings support the broad application of GLP-1 RAs for cardiorenal risk reduction and suggest considering body composition beyond BMI in treatment strategies.
Keywords:
Body mass indexCardiovascular diseaseChronic kidney diseaseGLP-1 receptor agonistsType 2 diabetes

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