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Purpose of Review <p>Whether body mass index (BMI) influences cardiovascular and kidney outcomes of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) in type 2 diabetes (T2DM) and to understand how metabolic phenotype may influence treatment response.</p> Recent Findings <p>Across randomized trials, GLP-1 RAs consistently reduced cardiovascular events in diverse populations, with no statistically significant heterogeneity by BMI. Observational analyses suggest that individuals with overweight or obesity may experience greater absolute cardiovascular risk reduction, potentially reflecting improvements in visceral adiposity, inflammation, and insulin resistance. In contrast, renal benefits such as slower decline in kidney function, reduced albuminuria, and delayed kidney failure were uniform across BMI categories. This BMI-independent nephroprotection aligns with mechanisms involving natriuresis, reduced oxidative and inflammatory injury, and attenuation of fibrotic pathways.</p> Summary <p> GLP-1 RAs provide clinically meaningful cardiovascular and kidney protection across the BMI spectrum. Cardiovascular benefits may be accentuated in individuals with elevated BMI, whereas renal benefits remain consistent regardless of adiposity. These findings support broad use of GLP-1 RAs for cardiorenal risk reduction and highlight the potential value of incorporating body-composition metrics beyond BMI in future treatment algorithms.</p>

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

  • 期刊论文

  • 发表日期：

    2026年3月25日

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  • Prerana Ramadurgum,
  • Kunal Sharma,
  • Alec Pinon,
  • Lakshmi Kattamuri,
  • Monica Botros

摘要

Purpose of Review

Whether body mass index (BMI) influences cardiovascular and kidney outcomes of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) in type 2 diabetes (T2DM) and to understand how metabolic phenotype may influence treatment response.

Recent Findings

Across randomized trials, GLP-1 RAs consistently reduced cardiovascular events in diverse populations, with no statistically significant heterogeneity by BMI. Observational analyses suggest that individuals with overweight or obesity may experience greater absolute cardiovascular risk reduction, potentially reflecting improvements in visceral adiposity, inflammation, and insulin resistance. In contrast, renal benefits such as slower decline in kidney function, reduced albuminuria, and delayed kidney failure were uniform across BMI categories. This BMI-independent nephroprotection aligns with mechanisms involving natriuresis, reduced oxidative and inflammatory injury, and attenuation of fibrotic pathways.

Summary

GLP-1 RAs provide clinically meaningful cardiovascular and kidney protection across the BMI spectrum. Cardiovascular benefits may be accentuated in individuals with elevated BMI, whereas renal benefits remain consistent regardless of adiposity. These findings support broad use of GLP-1 RAs for cardiorenal risk reduction and highlight the potential value of incorporating body-composition metrics beyond BMI in future treatment algorithms.