GLP-1 Therapies Enter the CKM Guideline For the first time, GLP-1-based therapy is recommended to reduce cardiac events

Abstract

Abstract
The 2026 CKM guideline integrates glucagon‑like peptide‑1 (GLP‑1)–based therapies into the armamentarium for cardiovascular and kidney risk reduction, recommending their use for select adults with obesity and/or type 2 diabetes who carry cardiovascular risk factors. This represents a paradigm shift that recognises GLP‑1 agents not only for glycaemic control and weight loss but as therapies capable of reducing major adverse cardiovascular events in appropriate populations. The guideline endorses a comorbidity‑guided approach—permitting SGLT2 inhibitors, GLP‑1–based therapy, or both—tailored to prevailing conditions such as chronic kidney disease with albuminuria, atherosclerotic cardiovascular disease, heart failure phenotypes, obesity, hyperglycaemia, or metabolic‑associated steatotic liver disease. For albuminuric CKD, the document recommends adding a nonsteroidal mineralocorticoid receptor antagonist or a GLP‑1 agent to background renin–angiotensin system inhibition and SGLT2 therapy when albuminuria persists. In HFpEF, GLP‑1 therapy is advised for patients with obesity or other CKM risk features. Mechanistic evidence points to GLP‑1 effects on visceral fat reduction, anti‑inflammatory signalling, and metabolic improvements that plausibly mediate cardiovascular protection. By positioning GLP‑1 agents alongside SGLT2 inhibitors and nonsteroidal MRAs, the guideline supports integrated, multi‑organ treatment strategies that align metabolic, renal, and cardiovascular goals. Clinicians should select GLP‑1 therapy based on individual risk profiles, therapeutic aims (weight reduction, glycaemia, ASCVD risk), and tolerability, embedding these agents into a holistic CKM care plan.