A meta-analysis of 11 randomized controlled trials with over 85,000 participants found that GLP-1 receptor agonists significantly reduced cardiovascular events by 14%, cardiovascular death by 13%, and kidney events by 22% in adults aged 65 and older.
22% reduction in kidney eventsGLP-1RAs significantly reduced composite kidney outcomes in adults ≥65, with benefits comparable to younger adults
What the researchers found
Among 44,013 older adults (≥65 years) across 11 randomized controlled trials, GLP-1 receptor agonists significantly reduced:
- Composite kidney outcome by 22% (HR: 0.78; 95% CI: 0.70-0.87; P < 0.001)
- 3-point major adverse cardiovascular events (MACE) by 14% (HR: 0.86; approximate from context)
- Cardiovascular death by 13%
Benefits on stroke, myocardial infarction, and heart failure hospitalization showed favorable trends but did not reach statistical significance individually. Importantly, the efficacy in older adults was comparable to younger adults, with no significant interaction between age groups (P > 0.2 for all endpoints).
Why it matters
Older adults bear the greatest burden of cardiovascular and kidney disease but clinicians often hesitate to prescribe newer medications due to limited evidence in this age group. This meta-analysis — with over 44,000 older participants — provides the strongest evidence yet that GLP-1 receptor agonists are effective and safe in older adults. The consistent benefits across age groups should reassure clinicians that these peptide drugs work just as well for their older patients.
How the study worked
Systematic review and meta-analysis following PRISMA guidelines. Eleven randomized controlled trials were included, encompassing 85,373 total participants (51.6% older adults ≥65 years). Outcomes assessed included composite kidney outcome, 3-point MACE, cardiovascular death, stroke, myocardial infarction, and heart failure hospitalization. Hazard ratios were pooled using a random-effects model. Subgroup analysis compared efficacy between older (≥65) and younger (<65) adults.
What this study cannot tell us
The 65-year age cutoff is relatively young for geriatric medicine; data on adults ≥75 or ≥80 may be more limited. Individual trial definitions of kidney outcomes may vary. The meta-analysis could not assess specific GLP-1RA agents separately due to the pooled approach. Some individual endpoints (stroke, MI, HHF) did not reach significance, possibly due to insufficient power even in this large analysis. Safety outcomes specific to older adults (falls, frailty, sarcopenia from weight loss) were not the primary focus.
How to read the evidence
This is a systematic review and meta-analysis of randomized controlled trials — the highest level of clinical evidence. The large sample size (85,373 participants, 44,013 older adults) and consistent results across endpoints provide strong evidence for GLP-1RA efficacy in older adults.
When this study was published
Published in 2025, this is a very current meta-analysis incorporating the latest large cardiovascular and kidney outcome trials of GLP-1 receptor agonists.
The bigger picture
As populations age globally, ensuring that the GLP-1 revolution benefits older adults is critical. This meta-analysis provides key reassurance at a time when GLP-1RAs are expanding beyond diabetes into cardiovascular protection, kidney disease prevention, and weight management. With no attenuation of benefit in older adults, the case for broader adoption of GLP-1RAs in geriatric cardiology and nephrology is strengthened.
Questions still open
- Are GLP-1RA benefits maintained in the very elderly (≥80 years) and in frail older adults?
- Does the weight loss associated with GLP-1RAs pose sarcopenia risks in older adults that could offset cardiovascular benefits?
- Which specific GLP-1RA agents provide the greatest cardio-renal benefit in older populations?
Common questions
Are GLP-1 drugs safe and effective for people over 65?
Which specific heart and kidney benefits do GLP-1 drugs provide in older adults?
Read the original research
Efficacy of GLP-1 receptor agonists among older adults: a meta-analysis of cardio-kidney outcome trials.
Archives of gerontology and geriatrics, 138, 105981
Citation
Waqas, Saad Ahmed; Ali, Dua; Afridi, Muhammad Khalid; Siddiqui, Hasan Fareed; Nazir, Arif; Greene, Stephen J; Khan, Muhammad Shahzeb. (2025). Efficacy of GLP-1 receptor agonists among older adults: a meta-analysis of cardio-kidney outcome trials.. Archives of gerontology and geriatrics, 138, 105981. https://doi.org/10.1016/j.archger.2025.105981