Sixteen trials (23,467 participants, median 68 weeks follow-up) were included, demonstrating that GLP-1 RAs reduced MACE by 20% (RR 0.80, 95% CI 0.72-0.89), with strongest effects on stroke (RR 0.72), myocardial infarction (RR 0.84), and heart failure hospitalization (RR 0.82), alongside reductions in systolic blood pressure (4.2 mmHg), triglycerides (32 mg/dL), and high-sensitivity C-reactive protein (hsCRP) (38.6%), with 12.4% weight loss where mediation analyses showed 35%-55% of cardiovascular benefit was independent of weight reduction. Here, GLP1R is linked to heart failure.