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

Celestino Sardu1,2, Ludovica Vittoria Marfella1, Carlo Fumagalli1

  • 1Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", 80126 Naples, Italy.

International Journal of Molecular Sciences
|October 29, 2025
PubMed

Insights

Glucagon-like peptide-1 receptor agonists (GLP-1 RA) slow ascending aorta dilatation in type 2 diabetes mellitus (T2DM) patients. This treatment may offer vasoprotective benefits beyond blood sugar control.

Area of Science:

  • Cardiovascular Medicine
  • Endocrinology
  • Diabetes Research

Background:

  • Ascending aorta dilatation is a concern in type 2 diabetes mellitus (T2DM).
  • Glucagon-like peptide-1 receptor agonists (GLP-1 RA) are used for T2DM management.
  • The vascular effects of GLP-1 RA beyond glycemic control are under investigation.

Purpose of the Study:

  • To evaluate the impact of GLP-1 RA therapy on the progression of subclinical ascending aortic dilatation in T2DM patients.
  • To explore potential vasoprotective mechanisms of GLP-1 RA in this context.

Main Methods:

  • Prospective study of 127 T2DM patients with subclinical ascending aortic dilatation.
  • Comparison between patients initiating GLP-1 RA (liraglutide, semaglutide, dulaglutide) and those on standard care.
  • Measurement of ascending aortic diameter via computed tomography angiography (CTA) at baseline and 24 months.
  • Assessment of vascular remodeling markers: MMP-9, TIMP-1, CRP, and OPG.

Main Results:

  • Significantly lower progression of aortic dilatation in the GLP-1 RA group compared to controls (+0.36 mm vs. +1.05 mm; p < 0.001).
  • GLP-1 RA therapy correlated with reduced MMP-9 and CRP levels.
  • GLP-1 RA therapy correlated with increased TIMP-1 and OPG levels.
  • GLP-1 RA use was an independent predictor of slower aortic dilatation progression.

Conclusions:

  • GLP-1 RA therapy is associated with reduced progression of ascending aortic dilatation in T2DM patients.
  • These findings suggest a potential vasoprotective role for GLP-1 RA, independent of glucose-lowering effects.
  • GLP-1 RA may represent a therapeutic option to mitigate cardiovascular risk in T2DM patients with aortic dilatation.
Keywords:
GLP-1 receptor agonistsascending aortic dilatationcomputed tomography angiographyinflammationtype 2 diabetes mellitusvascular biomarkers

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