SYSTEMATIC REVIEW article
Front. Endocrinol.
Sec. Clinical Diabetes
Volume 16 - 2025 | doi: 10.3389/fendo.2025.1554795
This article is part of the Research TopicOptimizing GLP-1 Receptor Agonist Use: Mechanisms, Clinical Applications, and Safety ProfilesView all 9 articles
Effect of semaglutide on arrhythmic, major cardiovascular, and microvascular outcomes in patients with type 2 diabetes: a systematic review and meta-analysis
Provisionally accepted
- 1Shenyang Pharmaceutical University, Shenyang, Liaoning Province, China
- 2Northern Theater Command General Hospital, Shenyang, Liaoning Province, China
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Background: Semaglutide, a glucagon-like peptide-1 (GLP-1) receptor agonist, has shown promise in managing hyperglycemia and reducing cardiovascular (CV) outcomes. However, its effects on arrhythmic, major CV, and microvascular outcomes remain uncertain. This systematic review and meta-analysis aimed to evaluate these outcomes in patients with type 2 diabetes (T2D) treated with semaglutide. Methods: We searched the PubMed, Embase, and Cochrane databases for eligible randomized controlled trials (RCTs) reported up to November 2024. We performed a meta-analysis via a random-effects model to estimate overall relative risks (RRs) with 95% confidence intervals (CIs) for arrhythmic, major CV, and microvascular outcomes. We conducted subgroup analyses on the basis of different administration types, treatment comparisons, and treatment durations. Addi-tionally, we performed a meta-regression for retinopathy complications on the basis of baseline patient characteristics. Results: This meta-analysis included 30 RCTs encompassing 32490 patients with T2D. Com-pared with the controls, semaglutide significantly reduced the incidence of atrial fibrillation (AF) (RR 0.73, 95% CI 0.54 to 0.98), complete atrioventricular (AV) block (RR 0.22, 95% CI 0.06 to 0.80), death from CV causes (RR 0.76, 95% CI 0.58 to 0.98), and revascularization (RR 0.68, 95% CI 0.52 to 0.88). Subgroup analyses revealed that semaglutide (long-term treatment) reduced the risk of AF, supraventricular tachycardia, and complete AV block. Meta-regression analysis re-vealed that the heterogeneity of retinopathy complications was not associated with baseline pa-tient characteristics. Conclusion: Semaglutide reduces the risk of AF, complete AV block, death from CV causes, and revascularization in patients with T2D, with long-term treatment showing greater benefits for arrhythmic outcomes.
Keywords: Semaglutide, Arrhythmic, cardiovascular, microvascular, type 2 diabetes, Meta-analysis
Received: 10 Jan 2025; Accepted: 15 Aug 2025.
Copyright: © 2025 Wu, Xing, Huang, Zhou, Sun, Yu and Wang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Liming Yu, Northern Theater Command General Hospital, Shenyang, 110017, Liaoning Province, China
Huishan Wang, Northern Theater Command General Hospital, Shenyang, 110017, Liaoning Province, China
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