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What Causes What
MECHANISM− DECREASES

GLP-1 receptor agonist → All-cause mortality

Higher GLP-1 receptor agonist decreases All-cause mortality.

In SELECT, weekly semaglutide 2.4 mg cut death from any cause versus placebo in 17,604 adults with overweight or obesity and established heart disease (hazard ratio 0.81; Lincoff 2023). Daily liraglutide did the same in type 2 diabetes (Marso 2016).

Randomized trial · Moderate · N=17604

Supported by an experiment or a tightly identified design. Read the caveats.

Mechanism

Fewer heart attacks and strokes mean fewer deaths. Weight, blood pressure, and glucose also fall. The count here is every recorded death, not only a cardiovascular certificate. Lincoff, Brown-Frandsen, Colhoun and colleagues (2023) assigned 17,604 people aged 45 or older with preexisting cardiovascular disease and a BMI of 27 or more, and no diabetes, to weekly semaglutide 2.4 mg or placebo. All-cause death was a prespecified secondary end point. Deaths: 375 of 8803 (4.3 percent) versus 458 of 8801 (5.2 percent). Hazard ratio 0.81 (95 percent CI 0.71 to 0.93). abstract_only. Marso, Daniels, Brown-Frandsen and colleagues (2016) assigned 9340 people with type 2 diabetes and high cardiovascular risk to daily liraglutide or placebo. Median follow-up was 3.8 years. Death from any cause: 381 of 4668 (8.2 percent) versus 447 of 4672 (9.6 percent). Hazard ratio 0.85 (0.74 to 0.97). full_text.

Caveats

Someone was assigned a pen, so the stamp is an RCT stamp. All-cause death was a prespecified secondary end point in both trials, not the primary three-point event count. In SELECT, cardiovascular death missed the hierarchical P value, so the all-cause hazard ratio is not a confirmatory test. LEADER reported P=0.02 for death from any cause. SELECT is secondary prevention without diabetes. LEADER is type 2 diabetes at high risk. Neither is a primary-prevention claim in lean people. Gut symptoms drove most dropouts. Did not hang FLOW kidney, the NASH-cirrhosis file, the MESA allocation paper, or the outcome-trial metas. Those are not a clean assigned death count in SELECT or LEADER. This page is a journal entry. It is not medical advice and not a reason to start or stop a drug.

Effect

odds_ratio = 0.81. SELECT all-cause HR 0.81 (0.71-0.93), 375 vs 458 deaths, N=17604, prespecified secondary. LEADER all-cause HR 0.85 (0.74-0.97), 381 vs 447, N=9340.

Nodes

Lifestyle & environmentGLP-1 receptor agonistBiology & endocrinologyAll-cause mortality

Named confounders

Cite this page

What Causes What. “GLP-1 receptor agonist → All-cause mortality.” https://whatcauseswhat.org/edges/e-glp1-mortality (atlas updated 2026-09-02).

https://whatcauseswhat.org/edges/e-glp1-mortality

Papers