GLP-1 Receptor Agonists Are Associated With Reduced Ascending Aorta Dilatation in Patients With Type 2 Diabetes: A Prospective Study

AIMS-To assess the impact of GLP-1 receptor agonist (GLP-1 RA) treatment on the progression of ascending aortic dilatation in patients with type 2 diabetes mellitus (T2DM), investigated with computed tomography angiography (CTA) and circulating biomarkers reflecting vascular remodeling. METHODS-A total of 127 T2DM patients with subclinical ascending aortic dilatation (diameter 35 mm < and ≤ 45 mm) were prospectively enrolled in this study. All were first-line naïve to GLP-1 RA. Fifty-seven patients started GLP-1 RA treatment (liraglutide, semaglutide, or dulaglutide) and 70 remained in routine care as controls. CTA was performed at baseline and 24 months to measure the ascending aortic diameter. Matrix metalloproteinase-9 (MMP-9), tissue inhibitor of metalloproteinases-1 (TIMP-1), C-reactive protein (CRP) and osteoprotegerin (OPG) were evaluated from sera at these two time points. RESULTS-The GLP-1 RA recipients, compared with controls, had the more limited progression of aortic dilatation (mean change, +0.36±0.20 mm vs+1.05±0.28 mm; P<0.001) at 24 months. Therapy correlated with decreased MMP-9 and CRP (P<0.01) and increased TIMP-1 and OPG (P<0.05). The use of GLP-1 RA was an independent predictor of low progression, even in multivariate models after adjusting for demographic, metabolic, and biomarker data. CONCLUSIONS-GLP-1 receptor agonist therapy has been associated with reduced ascending aortic dilatation in T2DM, suggesting a vasoprotective action beyond glucose lowering.