GLP-1 drugs reduce heart attacks with NNT of 207, MACE at NNT of 67, in largest cardiovascular meta-analysis | Research

The takeaway

Meta-analysis of 25 studies (109,846 patients) shows GLP-1 drugs reduce MI (RR 0.86, NNT 207), CV mortality (RR 0.87, NNT 170), MACE (RR 0.87, NNT 67), and stroke (RR 0.88, NNT 335), with greater MI benefit in higher BMI patients.

NNT 67 to prevent one MACE
The most comprehensive GLP-1 cardiovascular meta-analysis translates risk ratios into actionable NNTs: treat 67 patients for 3.5 years to prevent one major cardiovascular event

What the researchers found

MI: RR 0.86 (p<0.01), NNT 207. CV mortality: RR 0.87 (p<0.01), NNT 170. MACE: RR 0.87 (p<0.01), NNT 67. Stroke: RR 0.88 (p<0.01), NNT 335. Higher BMI → greater MI reduction (β=-0.09, p=0.03). GI AEs: RR 1.55, NNTH 9. 25 studies, 109,846 patients, 3.48 years.

Why it matters

NNT values make abstract risk ratios clinically actionable: treating 67 patients for 3.5 years prevents one MACE event, 170 prevents one CV death, 207 prevents one MI. These numbers help prescribers and patients weigh benefits versus costs.

How the study worked

Pairwise meta-analysis of 25 unique RCTs from Medline/Embase. Random-effects model. Primary: MI. Secondary: individual ASCVD components. Meta-regression for BMI. NNT/NNTH calculated.

What this study cannot tell us

Pooled different GLP-1 drugs. Follow-up duration varied. NNT depends on baseline risk. GI side effects common (NNTH 9) but mostly mild.

How to read the evidence

Meta-analysis of 25 RCTs with 109,846 patients. Highest quality cardiovascular evidence available for GLP-1 drugs.

When this study was published

Published in 2025; studies through May 2025.

The bigger picture

This is the definitive GLP-1 cardiovascular meta-analysis: large, comprehensive, with NNT values for clinical decision-making. It confirms GLP-1 drugs are one of the most impactful cardiovascular interventions in modern medicine.

Questions still open

Are NNTs comparable to statin cardiovascular NNTs?
Does BMI-dependent MI benefit support preferential use in heavier patients?
Would longer follow-up lower the NNT further?

Common questions

How effective are GLP-1 drugs at preventing heart attacks?

Very effective. This analysis of nearly 110,000 patients shows you need to treat 207 people with GLP-1 drugs for about 3.5 years to prevent one heart attack, and 67 people to prevent one major cardiovascular event. These numbers are comparable to or better than many established cardiovascular treatments.

What are the downsides of GLP-1 drugs for heart protection?

The main trade-off is GI side effects: nausea, vomiting, and diarrhea occur in about 1 in 9 patients (NNTH 9). However, these are mostly mild and manageable, whereas the cardiovascular benefits—preventing heart attacks, strokes, and cardiovascular death—are life-saving. The benefit clearly outweighs the risk for high-risk patients.

Read the original research

Glucagon-like peptide-1 receptor agonist in myocardial infarction and atherosclerotic cardiovascular disease risk reduction: a comprehensive meta-analysis of number needed to treat, efficacy and safety.

Cardiovascular diabetology, 24(1), 285

View on PubMed ↗Publisher’s paper ↗

Citation

Tang, Ansel Shao Pin; Hsu, Jovan Teng Yuan; Chong, Sheena Kar Shuan; Quek, Jingxuan; Shek, Genevieve; Sulaimi, Farisah; Chan, Kai En; Anand, Vickram Vijay; Chong, Bryan; Mehta, Anurag; Toh, Sue-Anne; Muthiah, Mark; Dimitriadis, Georgios K; le Roux, Carel W; Chan, Mark Yan-Yee; Mamas, Mamas Andreas; Chin, Yip Han; Chew, Nicholas W S. (2025). Glucagon-like peptide-1 receptor agonist in myocardial infarction and atherosclerotic cardiovascular disease risk reduction: a comprehensive meta-analysis of number needed to treat, efficacy and safety.. Cardiovascular diabetology, 24(1), 285. https://doi.org/10.1186/s12933-025-02840-3