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At the cellular level, GLP-1 agonists exert several beneficial effects: Cardiomyocyte protection : GLP-1 agonists inhibit receptor-interacting protein kinase 3/mixed lineage kinase domain-like pseudokinase-mediated myocardial necroptosis by activating the GLP-1R/PI3K/Akt pathway [5] Anti-fibrotic effects : These agents alleviate cardiac fibrosis and hypertrophy by upregulating atrial natriuretic peptide expression, which suppresses the calcineurin/nuclear factor of activated T cells 3 signaling pathway [5] Cellular stress reduction : GLP-1 agonists diminish endoplasmic reticulum stress and enhance autophagy in cardiomyocytes, preventing apoptosis and blocking progression to heart failure [5] Vascular effects : In vascular smooth muscle cells, GLP-1R activation primarily leads to Gs-mediated cAMP/PKA signaling while simultaneously inhibiting pro-proliferative pathways including ERK1/2 and p38 MAPK [4] Beyond these direct cellular effects, GLP-1 agonists improve cardiac function through multiple systemic mechanisms

Arsenic exists in different oxidation states and forms, of which inorganic form of geological origin is more toxic and present in ground water causing contamination of drinking water around the world (Lizama et al., 2011)

The clinical course was good

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