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While cardiovascular death alone didn't reach statistical significance (middle-left panel), consistent directional benefits appeared across heart failure outcomes and all-cause mortality, suggesting broad cardiovascular protection

This interaction underscores a broader metabolic complementarity: while GLP-1 RAs primarily drive weight loss through appetite suppression, delayed gastric emptying, and insulinotropic effects, microbiota-targeted interventions may act on additional pathways involved in energy expenditure, substrate utilization, and muscle preservation, thereby potentially reducing inter-individual variability in therapeutic outcomes

Gallstones and some hair loss have also been reported

Spirulina platensis alleviates high fat diet-induced cognitive impairment in mice via the gut-brain axis