Journal Article

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

Guarino, Giuseppina, Marfella, Lorenza, Mauro, Ciro, Sasso, Ferdinando Carlo, Bellis, Alessandro, Donisi, Isabella, Marinelli, Luca, Marfella, Raffaele, Rinaldi, Luca, Sellitto, Ausilia, Nappo, Francesco, Russo, Pasquale, D’Onofrio, Nunzia, Tarantino, Nicola Maria, Gentile, Sandro, Balestrieri, Maria Luisa, Cozzolino, Domenico, Furbatto, Fulvio, Cappabianca, Salvatore, Marfella, Ludovica Vittoria, Sardu, Celestino, Carusone, Caterina, Fumagalli, Carlo, Romano, Ciro, Satta, Ersilia, Carpinella, Gerardo

2025

Overview

The aim was to assess the impact of glucagon-like peptide-1 receptor agonists (GLP-1 RA) treatment on the progression of ascending aorta dilatation in patients with type 2 diabetes mellitus (T2DM). A total of 127 T2DM patients with subclinical ascending aortic dilatation (35–45 mm) were prospectively enrolled. Fifty-seven initiated GLP-1 RA therapy (liraglutide, semaglutide, or dulaglutide), while 70 continued on standard care. Ascending aortic diameter was measured by computed tomography angiography (CTA) at baseline and 24 months, alongside circulating markers of vascular remodeling: matrix metalloproteinase-9 (MMP-9), tissue inhibitor of metalloproteinases-1 (TIMP-1), C-reactive protein (CRP), and osteoprotegerin (OPG). Progression of aortic dilatation was significantly lower in the GLP-1 RA group compared with controls (+0.36 ± 0.20 mm vs. +1.05 ± 0.28 mm; p < 0.001). 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. GLP-1 RA therapy was associated with reduced progression of ascending aortic dilatation in T2DM, supporting a potential vasoprotective role beyond glucose lowering.

• Publisher: MDPI AG
• Subject: Aged / Agonists / Aneurysms / Angiography / Aorta - diagnostic imaging / Aorta - drug effects / Aorta - pathology / Biomarkers / Biomarkers - blood / Blood pressure / C-reactive protein / C-Reactive Protein - metabolism / Coronary vessels / Dextrose / Diabetes / Diabetes Mellitus, Type 2 - complications / Diabetes Mellitus, Type 2 - drug therapy / Diabetes therapy / Female / GLP-1 receptor agonists / Glucagon-Like Peptide 1 / Glucagon-Like Peptide-1 Receptor Agonists / Glucagon-Like Peptides - analogs & derivatives / Glucagon-Like Peptides - therapeutic use / Glucose / Humans / Hypoglycemic Agents - therapeutic use / Immunoglobulin Fc Fragments - therapeutic use / Inflammation / Male / Matrix Metalloproteinase 9 - blood / Matrix Metalloproteinase 9 - metabolism / Middle Aged / Osteoprotegerin - blood / Oxidative stress / Patient compliance / Patients / Prospective Studies / Recombinant Fusion Proteins - therapeutic use / Tissue Inhibitor of Metalloproteinase-1 - blood / Type 2 diabetes