Effect of semaglutide on arrhythmic, major cardiovascular, and microvascular outcomes in patients with type 2 diabetes: a systematic review and meta-analysis.

Wu R, Xing B, Huang Y, Zhou Z, Sun B, Yu L, Wang H

Frontiers in endocrinology26 Aug 2025Cited by 3 (Europe PMC)

PMID40933383PMCIDPMC12417197DOI10.3389/fendo.2025.1554795PepBankPUB-40933383

Summary

BackgroundSemaglutide, a glucagon-like peptide-1 (GLP-1) receptor agonist, has shown promise in managing hyperglycemia and reducing cardiovascular (CV) outcomes. However, its effects on arrhythmic, major CV, and microvascular outcomes remain uncertain. This systematic review and meta-analysis aimed to evaluate these outcomes in patients with type 2 diabetes (T2D) treated with semaglutide.MethodsWe searched the PubMed, Embase, and Cochrane databases for eligible randomized controlled trials (RCTs) reported up to November 2024. We performed a meta-analysis via a random-effects model to estimate overall relative risks (RRs) with 95% confidence intervals (CIs) for arrhythmic, major CV, and microvascular outcomes. We conducted subgroup analyses on the basis of different administration types, treatment comparisons, and treatment durations. Additionally, we performed a meta-regression for retinopathy complications on the basis of baseline patient characteristics.ResultsThis meta-analysis included 30 RCTs encompassing 32490 patients with T2D. Compared with the controls, semaglutide significantly reduced the incidence of atrial fibrillation (AF) (RR 0.73, 95% CI 0.54 to 0.98), complete atrioventricular (AV) block (RR 0.22, 95% CI 0.06 to 0.80), death from CV causes (RR 0.76, 95% CI 0.58 to 0.98), and revascularization (RR 0.68, 95% CI 0.52 to 0.88). Subgroup analyses revealed that semaglutide (long-term treatment) reduced the risk of AF, supraventricular tachycardia, and complete AV block. Meta-regression analysis revealed that the heterogeneity of retinopathy complications was not associated with baseline patient characteristics.ConclusionSemaglutide reduces the risk of AF, complete AV block, death from CV causes, and revascularization in patients with T2D, with long-term treatment showing greater benefits for arrhythmic outcomes.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/, identifier CRD42024618146.

CC BYText from Europe PMC. Highlighted sentences are the source of results.

Results from this study7

7 results from studies that gave the peptide. 7 results from people.

01HumanSystematic reviewEfficacy outcome
In patients with type 2 diabetes, pooled RCTs showed semaglutide reduced the incidence of atrial fibrillation versus controls (RR 0.73).
In plain wordsIn people with type 2 diabetes, pooled trials found semaglutide lowered the risk of atrial fibrillation compared with controls.
Peptide
Semaglutide
Outcome
DecreaseAtrial fibrillation
Study
n = 32,490
Comparator
Controls
Outcome group
Cardiovascular events · Cardiovascular
Studied dose
Dose not stated
Measurements
RR
0.73 ratio
atrial fibrillation
Source sentences
Summary
Compared with the controls, semaglutide significantly reduced the incidence of atrial fibrillation (AF) (RR 0.73, 95% CI 0.54 to 0.98), complete atrioventricular (AV) block (RR 0.22, 95% CI 0.06 to 0.80), death from CV causes (RR 0.76, 95% CI 0.58 to 0.98), and revascularization (RR 0.68, 95% CI 0.52 to 0.88).
2 context sentences(design, population, supporting numbers)
Title · context
Effect of semaglutide on arrhythmic, major cardiovascular, and microvascular outcomes in patients with type 2 diabetes: a systematic review and meta-analysis.
Summary · context
This meta-analysis included 30 RCTs encompassing 32490 patients with T2D.
Show in the study text Report a problemFND-4093338301
02HumanSystematic reviewEfficacy outcome
In patients with type 2 diabetes, pooled RCTs showed semaglutide reduced the incidence of complete AV block versus controls (RR 0.22).
In plain wordsIn people with type 2 diabetes, pooled trials found semaglutide lowered the risk of complete heart block compared with controls.
Peptide
Semaglutide
Outcome
DecreaseComplete atrioventricular block
Study
n = 32,490
Comparator
Controls
Outcome group
Cardiovascular events · Cardiovascular
Studied dose
Dose not stated
Measurements
RR
0.22 ratio
complete AV block
Source sentences
Summary
Compared with the controls, semaglutide significantly reduced the incidence of atrial fibrillation (AF) (RR 0.73, 95% CI 0.54 to 0.98), complete atrioventricular (AV) block (RR 0.22, 95% CI 0.06 to 0.80), death from CV causes (RR 0.76, 95% CI 0.58 to 0.98), and revascularization (RR 0.68, 95% CI 0.52 to 0.88).
2 context sentences(design, population, supporting numbers)
Title · context
Effect of semaglutide on arrhythmic, major cardiovascular, and microvascular outcomes in patients with type 2 diabetes: a systematic review and meta-analysis.
Summary · context
This meta-analysis included 30 RCTs encompassing 32490 patients with T2D.
Show in the study text Report a problemFND-4093338302
03HumanSystematic reviewEfficacy outcome
In patients with type 2 diabetes, pooled RCTs showed semaglutide reduced death from CV causes versus controls (RR 0.76).
In plain wordsIn people with type 2 diabetes, pooled trials found semaglutide lowered the risk of heart-related death compared with controls.
Peptide
Semaglutide
Outcome
DecreaseDeath from cardiovascular causes
Study
n = 32,490
Comparator
Controls
Outcome group
Mortality · Cardiovascular
Studied dose
Dose not stated
Measurements
RR
0.76 ratio
death from CV causes
Source sentences
Summary
Compared with the controls, semaglutide significantly reduced the incidence of atrial fibrillation (AF) (RR 0.73, 95% CI 0.54 to 0.98), complete atrioventricular (AV) block (RR 0.22, 95% CI 0.06 to 0.80), death from CV causes (RR 0.76, 95% CI 0.58 to 0.98), and revascularization (RR 0.68, 95% CI 0.52 to 0.88).
2 context sentences(design, population, supporting numbers)
Title · context
Effect of semaglutide on arrhythmic, major cardiovascular, and microvascular outcomes in patients with type 2 diabetes: a systematic review and meta-analysis.
Summary · context
This meta-analysis included 30 RCTs encompassing 32490 patients with T2D.
Show in the study text Report a problemFND-4093338303
04HumanSystematic reviewEfficacy outcome
In patients with type 2 diabetes, pooled RCTs showed semaglutide reduced revascularization versus controls (RR 0.68).
In plain wordsIn people with type 2 diabetes, pooled trials found semaglutide lowered the need for artery reopening procedures compared with controls.
Peptide
Semaglutide
Outcome
DecreaseRevascularization
Study
n = 32,490
Comparator
Controls
Outcome group
Cardiovascular events · Cardiovascular
Studied dose
Dose not stated
Measurements
RR
0.68 ratio
revascularization
Source sentences
Summary
Compared with the controls, semaglutide significantly reduced the incidence of atrial fibrillation (AF) (RR 0.73, 95% CI 0.54 to 0.98), complete atrioventricular (AV) block (RR 0.22, 95% CI 0.06 to 0.80), death from CV causes (RR 0.76, 95% CI 0.58 to 0.98), and revascularization (RR 0.68, 95% CI 0.52 to 0.88).
2 context sentences(design, population, supporting numbers)
Title · context
Effect of semaglutide on arrhythmic, major cardiovascular, and microvascular outcomes in patients with type 2 diabetes: a systematic review and meta-analysis.
Summary · context
This meta-analysis included 30 RCTs encompassing 32490 patients with T2D.
Show in the study text Report a problemFND-4093338304
05HumanSystematic reviewEfficacy outcome
In patients with type 2 diabetes, long-term semaglutide treatment reduced the risk of atrial fibrillation in subgroup analysis.
In plain wordsIn people with type 2 diabetes, longer semaglutide treatment lowered the risk of atrial fibrillation in pooled trials.
Peptide
Semaglutide
Outcome
DecreaseAtrial fibrillation, long-term treatment subgroup
Study
n: not reported in source
Comparator
Controls
Outcome group
Cardiovascular events · Cardiovascular
Studied dose
Dose not stated
Source sentences
Summary
Subgroup analyses revealed that semaglutide (long-term treatment) reduced the risk of AF, supraventricular tachycardia, and complete AV block.
2 context sentences(design, population, supporting numbers)
Title · context
Effect of semaglutide on arrhythmic, major cardiovascular, and microvascular outcomes in patients with type 2 diabetes: a systematic review and meta-analysis.
Summary · context
This meta-analysis included 30 RCTs encompassing 32490 patients with T2D.
Show in the study text Report a problemFND-4093338305
06HumanSystematic reviewEfficacy outcome
In patients with type 2 diabetes, long-term semaglutide treatment reduced the risk of supraventricular tachycardia in subgroup analysis.
In plain wordsIn people with type 2 diabetes, longer semaglutide treatment lowered the risk of a fast heart rhythm from the upper heart in pooled trials.
Peptide
Semaglutide
Outcome
DecreaseSupraventricular tachycardia, long-term treatment subgroup
Study
n: not reported in source
Comparator
Controls
Outcome group
Cardiovascular events · Cardiovascular
Studied dose
Dose not stated
Source sentences
Summary
Subgroup analyses revealed that semaglutide (long-term treatment) reduced the risk of AF, supraventricular tachycardia, and complete AV block.
2 context sentences(design, population, supporting numbers)
Title · context
Effect of semaglutide on arrhythmic, major cardiovascular, and microvascular outcomes in patients with type 2 diabetes: a systematic review and meta-analysis.
Summary · context
This meta-analysis included 30 RCTs encompassing 32490 patients with T2D.
Show in the study text Report a problemFND-4093338306
07HumanSystematic reviewEfficacy outcome
In patients with type 2 diabetes, long-term semaglutide treatment reduced the risk of complete AV block in subgroup analysis.
In plain wordsIn people with type 2 diabetes, longer semaglutide treatment lowered the risk of complete heart block in pooled trials.
Peptide
Semaglutide
Outcome
DecreaseComplete atrioventricular block, long-term treatment subgroup
Study
n: not reported in source
Comparator
Controls
Outcome group
Cardiovascular events · Cardiovascular
Studied dose
Dose not stated
Source sentences
Summary
Subgroup analyses revealed that semaglutide (long-term treatment) reduced the risk of AF, supraventricular tachycardia, and complete AV block.
2 context sentences(design, population, supporting numbers)
Title · context
Effect of semaglutide on arrhythmic, major cardiovascular, and microvascular outcomes in patients with type 2 diabetes: a systematic review and meta-analysis.
Summary · context
This meta-analysis included 30 RCTs encompassing 32490 patients with T2D.
Show in the study text Report a problemFND-4093338307

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Version history

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Version 2Current
11 Oct 2026, 00:04 UTC
Study results updated
Version 1
9 Oct 2026, 03:06 UTC
First added · source update from Europe PMC

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Effect of semaglutide on arrhythmic, major cardiovascular, and microvascular outcomes in patients with type 2 diabetes: a systematic review and meta-analysis.

Summary

Results from this study7

Version history

Subjects

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MeSH terms

Keywords