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GLP-1 Receptor Agonists Reduce Aortic Dissection and Hypertensive Crisis in Diabetic Patients with Aortic Aneurysm: A

Yung-Fong Tsai1,2, Huan-Tang Lin1,2,3, Yu-Fang Liu4

  • 1Department of Anesthesiology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.

Diabetes, Metabolic Syndrome and Obesity : Targets and Therapy
|June 1, 2026
PubMed

Insights

Glucagon-like peptide-1 receptor agonists (GLP-1RAs) may reduce aortic events and mortality in diabetic patients with aortic aneurysms. This study found GLP-1RA therapy linked to lower risks of rupture, dissection, and death compared to other diabetes drugs.

Area of Science:

  • Cardiovascular Medicine
  • Endocrinology
  • Pharmacology

Background:

  • Aortic aneurysm rupture and dissection are highly fatal, with limited evidence-based therapies.
  • Glucagon-like peptide-1 receptor agonists (GLP-1RAs) show potential for stabilizing vascular inflammation.
  • No large-scale studies have assessed GLP-1RAs' impact on acute aortic events in diabetic patients with aortic aneurysms.

Purpose of the Study:

  • To evaluate the impact of GLP-1RA therapy on acute aortic events in patients with type 2 diabetes and pre-existing aortic aneurysms.
  • To compare the incidence of aortic rupture/dissection, hypertensive crisis, and all-cause mortality between GLP-1RA users and dipeptidyl peptidase-4 inhibitor (DPP-4i) users.

Main Methods:

  • Retrospective active-comparator new-user cohort study using TriNetX data (2016-2023) from 152 US healthcare organizations.
  • Identified 11,581 adults with type 2 diabetes and non-ruptured aortic aneurysm initiating GLP-1RA (n=5676) or DPP-4i (n=5905).
  • Propensity-score matched 3857 patients per group for analysis using Cox proportional hazards models.

Main Results:

  • GLP-1RA therapy was associated with a significantly lower risk of aortic rupture/dissection requiring surgical repair (HR 0.75, P=0.013).
  • GLP-1RA use was linked to reduced risks of hypertensive crisis (HR 0.77, P=0.022) and all-cause mortality (HR 0.64, P<0.001).
  • Numbers needed to treat over 5 years were 60 for aortic events, 81 for hypertensive crisis, and 14 for all-cause mortality.

Conclusions:

  • GLP-1RA therapy is associated with a lower incidence of aortic rupture/dissection, hypertensive crisis, and mortality in diabetic patients with aortic aneurysms.
  • These findings support the preferential consideration of GLP-1RAs for managing type 2 diabetes in this high-risk population.
  • GLP-1RAs may offer a protective effect against severe aortic complications and mortality.
Abstract

Keywords:
aortic aneurysmaortic dissectioncardiovascular outcomesdiabetes mellitusglucagon-like peptide-1 receptor agonistreal-world evidence

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