GLP-1 RECEPTOR AGONISTS: A NARRATIVE REVIEW OF THEIR ROLE ACROSS MULTIPLE ORGAN SYSTEMS BEYOND WEIGHT MANAGEMENT

*Alabi Damilola, Fatima Zehra, Mohsin Babar, Chad Barker, Muhammad Ahsan Shaikh MBBS, MD, Syeddah Saiqa Gillani, Hirak Trivedi, Humaira Kousar, Surriya Kousar

Background: Glucagon-like peptide-1 receptor agonists (GLP-1RAs), originally formulated to improve glycemic control in type 2 diabetes mellitus and subsequently leveraged for weight management, have demonstrated wide-ranging pleiotropic effects across multiple organ systems. These extra-metabolic capabilities suggest that their therapeutic utility extends far beyond simple adiposity reduction. Objective: This narrative review aims to comprehensively synthesize and critically appraise clinical and mechanistic evidence regarding the long-term impacts of GLP-1RAs-specifically long-acting analogs such as semaglutide and the dual glucose-dependent insulinotropic polypeptide (GIP)/GLP-1 receptor agonist tirzepatide-on cardiovascular, renal, hepatic, pulmonary, and neurological outcomes. Methods: A detailed, comprehensive literature search was executed across PubMed, Embase, and regulatory databases (such as the US Food and Drug Administration) to identify milestone phase III randomized controlled trials, robust real-world evidence, systematic reviews, and meta-analyses published between January 2021 and May 2026. Key Findings: Accumulating data reveal that GLP-1RAs significantly decrease major adverse cardiovascular events (MACE) through mechanisms involving plaque stabilization, endothelial protection, and macrophage phenotypic polarization. In obesity-driven heart failure with preserved ejection fraction (HFpEF), these agents markedly enhance functional capacity and mitigate symptoms by reducing epicardial adipose tissue volume and localized paracrine inflammation. Furthermore, landmark clinical trials have confirmed that GLP-1RAs slow the progression of chronic kidney disease (CKD), reduce albuminuria, and provide direct podocyte preservation. In hepatology, GLP-1RAs facilitate the resolution of metabolic dysfunction-associated steatohepatitis (MASH) and arrest hepatic fibrosis, culminating in recent regulatory approvals. Emerging evidence also highlights neuroprotective qualities, including a reduction in neuroinflammation and a deceleration of cognitive decline in neurodegenerative diseases, alongside unexpected efficacy in reducing the severity of obstructive sleep apnea and modulating central reward pathways associated with substance use disorders. Conclusion: GLP-1RAs represent a profound shift in chronic disease management, transitioning from targeted metabolic modifiers into broad systemic therapies that directly counter the inflammatory and fibrotic drivers of multi-organ dysfunction.