AIMS: To evaluate the cardiovascular efficacy of glucagon-like peptide-1 receptor agonists (GLP-1RAs) in Asian, Black or African American, and White populations, and to assess whether the magnitude of cardiovascular risk reduction differs across these populations.
MATERIALS AND METHODS: PubMed and EMBASE were searched to 11 November 2025 for randomized placebo-controlled GLP-1RA trials in adults with type 2 diabetes or overweight/obesity that reported race-stratified major adverse cardiovascular events (MACE; cardiovascular death, non-fatal myocardial infarction, or non-fatal stroke). Hazard ratios (HRs) for MACE were extracted for Asian, Black or African American, and White populations. Random-effects meta-analyses were used to obtain pooled HRs and ratios of HRs (RHRs) comparing treatment effects between populations.
RESULTS: Nine trials, including the recent SOUL trial, were included, comprising 8164 Asian, 4036 Black or African American, and 62 503 White participants. GLP-1RAs reduced MACE risk in Asian (HR 0.73; 95% CI 0.63-0.85; p < 0.001) and White populations (HR 0.86; 95% CI 0.81-0.91; p < 0.001). In Black or African American populations, the effect was similar to that in White populations (HR 0.88; 95% CI 0.67-1.15; p = 0.34) but did not reach statistical significance. The pooled RHR for Asian versus White populations was 0.84 (95% CI 0.71-0.98; p = 0.027), indicating a significantly greater risk reduction in Asian populations. The RHR for Asian versus Black or African American populations was 0.81 (95% CI 0.57-1.16; p = 0.25), with point estimates favouring Asian populations.
CONCLUSIONS: GLP-1RAs reduced MACE risk across populations, with greater relative risk reduction in Asian populations and broadly similar benefits in Black or African American and White populations.
| Discipline Area | Score |
|---|---|
| Physician |  |
Physician rater
This is helpful information, as the vast majority of patients enrolled in RCTs of GLP-1 agonists have been white. The major limitation of this analysis is that it ignores Hispanic ethnicity. The standard has been to compare non-Hispanic Blacks, non-Hispanic Asians, and Hispanics to non-Hispanic white subgroups. Of note, there is a large amount of heterogeneity in the outcomes for the Black subgroup. In addition, there is heterogeneity in the weight loss outcomes associated with the different GLP-1 agonists, which may translate into heterogeneity in CVD outcomes. Finally, it would have been useful to include the tirzepatide CVOT results.
Physician rater
In my view, these results will not affect clinical practice. They are explained by an increased risk in Asian patients and the lower number of participants in Black/African American patients, accounting for the lack of statistical significance (the HRs were the same as in white participants). Clinician use of GLP-1s will not be affected by race/ethnicity.
, McMaster University