Published: January 21, 2026
Cardiometabolic care is undergoing a transformation that includes the rise of prescribing GLP-1 receptor agonists as multisystem therapeutics.“Treating diabetes, cardiovascular disease and renal or hepatic dysfunction as isolated conditions is now an outdated approach in cardiometabolic care,” said Catrina R. Hancock, PA-C, physician assistant with Norton Heart & Vascular Institute. “Instead, treatment has shifted toward more comprehensive, integrated management that reflects the true physiological interconnectedness of cardiometabolic disease.”
Cardiometabolic syndrome affects the heart, kidneys, liver, vascular endothelium and adipose tissue.
“Only 6.8% of American adults are considered cardiovascularly or cardiometabolically healthy,” Catrina said. “This decline shows the urgency for more effective, systemwide interventions.”Obesity and chronic hyperglycemia remain central contributors to the disease. As clinical understanding evolves, it has become clear that adipose tissue is not a passive reservoir but an active inflammatory organ driving disease progression across multiple organ systems, according to Catrina.
GLP-1 receptor agonists have emerged as a preferred first-line therapy because they can address cardiometabolic disease across multiple organ systems.While their roles in glycemic control and weight reduction are well established, the broader clinical impact involves cardiovascular protection, reduced heart failure hospitalization risk, renal support and hepatic benefits for patients with existing or emerging cardiometabolic disease.
“When you take a GLP-1, it’s a two-in-one, three-in-one, four-in-one treatment,” Hancock said. “You’re going to treat your diabetes; you’re going to help your heart. You’re going to help your kidneys, and you’re going to help your liver.”
Several mechanisms contribute to the benefits from GLP-1s, including antiatherosclerotic effects, blood pressure reduction, decreased platelet aggregation and cognitive impact, plus a metabolic dysfunction–associated steatohepatitis (MASH) indication for patients with fatty liver disease.
GLP-1 receptor agonists can be initiated as first-line therapy in place of older metformin-focused pathways, according to Catrina. Medication selection should align with patient-specific needs.For those with established cardiovascular disease, agents with demonstrated cardiovascular outcome benefits, such as semaglutide (Ozempic), may be preferred. Patients with obesity-related heart failure who require more significant weight reduction may derive greater benefit from tirzepatide (Mounjaro).A chronic kidney disease (CKD) indication expands opportunities for renal support, while the MASH indication addresses hepatic involvement.
Rigid specialty silos no longer serve patients effectively, according to Catrina.“We can’t say any longer that, ‘I am going to stay in my lane, and I’m not going to treat kidney disease. I am not going to treat diabetes’” she said.While primary care providers can initiate cardiometabolic treatments such as GLP-1 therapy, other specialties may integrate them into treatments as well. By embracing these therapies and fostering collaborative care, clinicians can improve cardiometabolic health outcomes.Referral to cardiology is necessary for patients with known cardiovascular disease needing comprehensive risk assessment, for those with complex heart failure phenotypes or when navigating more nuanced medication interactions.
Norton Heart & Vascular Institute’s cardiometabolic clinic provides comprehensive care for patients with diabetes, heart disease, chronic kidney disease, obesity, high blood pressure and high cholesterol.