Description
The 2026 CKM guideline formally endorses GLP‑1–based therapies as cardioprotective agents for select people with obesity and/or type 2 diabetes who carry cardiovascular risk factors, marking a shift beyond glucose‑ and weight‑centric use. Recommendations favour a comorbidity‑guided approach—SGLT2 inhibitors, GLP‑1 therapy, or both—tailored to dominant conditions such as CKD with albuminuria, ASCVD, heart failure phenotypes, obesity, hyperglycaemia, or MASLD. For persistent albuminuria, a GLP‑1 agent or a nonsteroidal MRA may be added to RAS blockade plus SGLT2 inhibition; in HFpEF, GLP‑1 therapy is advised for patients with obesity or CKM risk features. Mechanistic and trial data support multi‑organ benefits via visceral fat reduction, anti‑inflammatory effects, and metabolic improvements that plausibly lower cardiovascular events. The guideline’s nuanced placement empowers individualized therapy selection to prioritise the patient’s principal comorbidity while recognising GLP‑1 drugs as deliberate tools to reduce hard cardiac and kidney outcomes within an integrated CKM treatment framework.