Obesity is an independent driver of cardiovascular disease (CVD), mediated through adverse haemodynamic loading, insulin resistance, systemic inflammation, endothelial dysfunction and prothrombotic pathways. Contemporary obesity therapies show cardiovascular (CV) benefits beyond improvements in traditional risk factors. Across large CV outcome trials, glucagon-like peptide 1 receptor agonists consistently reduce three-point major adverse CV events (MACE) in patients with overweight, obesity and established CVD with and without diabetes. In obesity-related heart failure of preserved ejection fraction, semaglutide and tirzepatide improve symptoms and functional capacity and reduce worsening heart failure events, while effects on CV mortality remain uncertain.