GLP-1 Receptor Agonists Associated With Improved Survival After Infrainguinal Bypass in Diabetic Patients

The American Diabetes Association recommends the use of glucagon-like-peptide-1 receptor agonists (GLP1-RAs) (e.g., Ozempic) for patients with atherosclerotic cardiovascular disease, including peripheral artery disease. We hypothesized increasing the use of GLP1-RAs would be associated with improved outcomes after bypass.

Retrospective review of diabetic patients undergoing infrainguinal bypass at a multihospital institution between 2017 and 2024 was conducted, including patient characteristics, operative details, and outcomes. The primary outcome was survival. Secondary outcomes included perioperative complications, major adverse limb events, major adverse cardiovascular events (MACE), and metabolic changes. Kaplan-Meier and Cox regression evaluated outcomes.

A total of 322 patients (62.5% male, 78.8% White, median age 68 [61-76] years) underwent 339 bypasses. GLP1-RA use increased from 8.2% to 18.8% during the study period (P = 0.001). Patients on a GLP1-RA (n = 38, 11.2%) were younger (65.5 [57.0-71.0] vs. 69.9 [62.0-77.0] years, P = 0.003) and had a higher body mass index (29.6 [26.9-33.3] vs. 27.2 [23.3-31.1] kg/m², P < 0.001). Median follow-up was 18 [6-39] months. Improved survival at 2 years was seen among patients on a GLP1-RA (94.7% vs. 71.8%, P = 0.004). On adjusted analysis, GLP1-RA use was associated with reduced mortality (adjusted hazard ratio = 0.09, 95% confidence interval 0.01-0.66, P = 0.02). Freedom from MACE at 2 years was greater among patients on a GLP-1-RA (100% vs. 88.6%, P = 0.046). Freedom from major adverse limb events was similar between groups.

GLP1-RA use is increasingly common in patients undergoing lower extremity bypass and was associated with significantly improved postoperative survival and freedom from MACE. Further studies are required to confirm reasons for differences in outcomes.