Comparing Cardiovascular Outcomes of GLP-1 Receptor Agonists Versus Metabolic Bariatric Surgery: A Systematic Review and Meta-Analysis

INTRODUCTION: Obesity significantly increases cardiovascular risk through insulin resistance, dyslipidemia, hypertension, and systemic inflammation. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) and metabolic bariatric surgery (MBS) are effective weight-loss interventions that may improve cardiovascular outcomes. However, evidence comparing the long-term cardiovascular benefits of GLP-1RAs versus MBS remains limited. We systematically compare the impact of GLP-1RAs versus MBS on cardiovascular outcomes, including major adverse cardiovascular events (MACE), and heart failure (HF) in patients with obesity. METHODS: We conducted a systematic review and meta-analysis following PRISMA 2020 guidelines. PubMed, Scopus, Web of Science, and Embase were searched up to July 30, 2025, for studies comparing cardiovascular outcomes of GLP-1RAs and MBS. Inclusion criteria encompassed studies reporting cardiovascular disease (CVD), including MACE and HF. Risk of bias was assessed using the Newcastle-Ottawa Scale. Random-effects meta-analyses were performed using the R meta package. Heterogeneity was evaluated with I² statistics, and publication bias was assessed via funnel plots and Egger's test. RESULTS: Six cohort studies, including over 282,450 participants, compared cardiovascular outcomes of MBS versus GLP-1RAs. MBS was associated with a significantly lower prevalence of CVD (RR = 0.63; 95% CI: 0.49-0.81; I² = 87.7%) and HF (RR = 0.50; 95% CI: 0.37-0.66; I² = 70.2%) compared to GLP-1RAs. For cerebrovascular events, a non-significant trend favored MBS (RR = 0.68; 95% CI: 0.34-1.36; I² = 91%). Sensitivity analyses confirmed the robustness of these findings, and no significant publication bias was detected. CONCLUSIONS: Compared to GLP-1RAs, metabolic bariatric surgery is linked to better cardiovascular outcomes and a decreased prevalence of heart failure in individuals with obesity. Although trends point to possible cerebrovascular benefits, there is insufficient research to draw firm conclusions. These findings might help physicians tailor their approaches to managing obesity in order to maximize the reduction of cardiovascular prevalence.