Guest Editor: Dr Amina Rakisheva, Scientific Research Institute of Cardiology and Internal Medicine, Almaty, Kazakhstan 

This Cardiac Failure Review special collection unites four expert reviews examining the emerging cardiovascular role of glucagon-like peptide-1 receptor agonists (GLP-1RAs) across the spectrum of heart failure (HF). Initially developed for glycaemic control in type 2 diabetes, GLP-1RAs have been demonstrated to have significant cardiometabolic benefits, including weight reduction, blood pressure lowering, improved endothelial function and anti-inflammatory effects, that may be particularly relevant in obesity-related HF with preserved ejection fraction (HFpEF). 

Abdelhamid et al. synthesise mechanistic and clinical insights, outlining the evolving evidence base that supports GLP-1RAs in patients with HFpEF and obesity, while clarifying the limited efficacy in HF with reduced ejection fraction. The authors emphasise the need to identify optimal candidates and to integrate GLP-1RAs within a multidimensional cardiometabolic approach. 

The article by Bonfioli et al. explores the mechanistic pathways and translational evidence for GLP-1RAs as novel agents in HF management. It highlights their potential to improve metabolic, vascular and renal health and reduce systemic inflammation, positioning them as candidates for treating the broader cardiovascular–kidney–metabolic syndrome. 

The manuscript by Bykova et al. focuses on the heterogeneity of HFpEF, analysing how GLP-1RA mechanisms may benefit distinct phenotypes, those associated with diabetes, obesity, hypertension, AF and coronary disease, through weight reduction, anti-inflammatory and vasodilatory effects. 

Finally, Shchendrygina et al. review clinical and experimental data on GLP-1RAs and surrogate HF outcomes, including cardiac function, exercise capacity and quality of life, summarising evidence from small studies and recent trials (e.g. STEP-HFpEF) and calling for large, outcome-driven investigations. 

Together, these articles define a forward-looking agenda: repositioning GLP-1RAs from diabetes therapy to potential cornerstone agents in cardiometabolic and HF care, bridging metabolic and cardiac disciplines to improve outcomes for this expanding patient population.