Cardiovascular Benefits of GLP-1 and Dual GIP/GLP-1 Agonists: A Paradigm Shift in Cardiology and Metabolic Care

Resumen

The emergence of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and dual glucose-dependent insulinotropic polypeptide/glucagon-like peptide-1 receptor agonists (GIP/GLP-1 RAs) has redefined cardiovascular prevention and metabolic care. This review analyzes the cardiovascular, renal, and metabolic outcomes associated with these therapies, integrating evidence from major outcome trials—LEADER, SUSTAIN-6, REWIND, AMPLITUDE-O, and SELECT—and emerging dual incretin studies such as SUMMIT and SURPASS-CVOT. Across these trials, GLP-1 RAs consistently reduced major adverse cardiovascular events (MACE), cardiovascular mortality, and kidney disease progression, demonstrating benefits that extend beyond glycemic control. Mechanistic data reveal anti-inflammatory, endothelial, and neurohumoral pathways that collectively explain their cardioprotective profile. The new generation of dual incretin agonists, exemplified by tirzepatide, provides unprecedented improvements in weight reduction, insulin sensitivity, and heart failure symptoms, marking a new frontier in cardiometabolic therapeutics. For Latin American countries, including Mexico, Colombia, and Ecuador, the clinical translation of these findings faces barriers such as high cost, limited access, and physician unfamiliarity. However, strategic health policies and regional collaboration could integrate incretin-based therapy into national cardiovascular prevention frameworks. Ultimately, incretin therapy represents a paradigm shift from glucose-centric management toward comprehensive, preventive, and equitable cardiometabolic care with global implications.