The Association Between Glucagon-like Peptide-1 Receptor Agonists and Clinical Outcomes in Patients with Thoracic Aortic Aneurysm

Mohammad Alaa Raslan; Hussein Abdul Nabi; Luke Dreher; Soad Al Osta; Vinicius De Sousa Barzon Serra; Chadi Ayoub; Hicham El Masry; Fadi E Shamoun

doi:10.3390/diagnostics16111742

The Association Between Glucagon-like Peptide-1 Receptor Agonists and Clinical Outcomes in Patients with Thoracic Aortic Aneurysm

Diagnostics (Basel). 2026 Jun 5;16(11):1742. doi: 10.3390/diagnostics16111742.

Authors

Mohammad Alaa Raslan^{1

2}, Hussein Abdul Nabi¹, Luke Dreher¹, Soad Al Osta³, Vinicius De Sousa Barzon Serra¹, Chadi Ayoub¹, Hicham El Masry¹, Fadi E Shamoun¹

Affiliations

¹ Department of Cardiovascular Medicine, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ 85054, USA.
² Department of Internal Medicine, University of Michigan Health-Sparrow, 1215 E Michigan Ave, Lansing, MI 48912, USA.
³ Department of Internal Medicine, MedStar Health Georgetown University, Baltimore, MD 21218, USA.

Abstract

Background/Objectives: Thoracic aortic aneurysm (TAA) often results from structural degeneration of the aortic wall. Traditional management focuses on hemodynamic control using beta-blockers (BB) and angiotensin receptor blockers (ARBs). Glucagon-like peptide-1 receptor agonists (GLP-1 RAs), originally developed for diabetes and weight management, may offer additional vascular protective benefits through anti-inflammatory, antioxidative, and matrix-stabilizing mechanisms. However, their role in reducing mortality and thoracic aortic dissection (TAD) risk in patients with TAA has not been evaluated in human populations. In this study, we aimed to assess the association between GLP-1 RA use and the risks of mortality and thoracic aortic dissection. Methods: We conducted a retrospective cohort study of adults diagnosed with TAA between 2018 and 2024 across three Mayo Clinic sites. Patients receiving GLP-1 RAs were compared with non-users using 1:1 propensity score matching. Outcomes included all-cause mortality, cardiovascular mortality, and incident TAD. Kaplan-Meier and Cox proportional hazards analyses were performed. Results: A total of 32,279 patients with TAA, with a median age of 68.0 [IQR: 59.0-76.0] and 70.7% male, were included in a 1:1 propensity score match. This yielded a balanced cohort of 588 GLP-1 RA users and 588 non-users. Through a median follow-up of 4.1 (2.2, 5.9) years, GLP-1 RA use was associated with significantly lower 5-year cumulative incidence of all-cause mortality (5.0% vs. 14.5%, HR: 0.31; 95% CI: 0.19-0.50; p < 0.001), cardiovascular mortality (1.9% vs. 5.5%, HR: 0.30; 95% CI: 0.13-0.70; p = 0.005), and TAD (0.9% vs. 4.0%, HR: 0.19; 95% CI: 0.06-0.60; p < 0.0004). Conclusions: GLP-1 RAs are associated with reduced incidence of all-cause mortality, cardiovascular mortality, and TAD incidence in patients with TAA. Prospective studies are needed to confirm these findings and evaluate effects on aneurysm progression.

Keywords: aorta; cardiovascular outcomes; glucagon-like peptide-1 receptor agonists; mortality; thoracic aortic aneurysm; thoracic aortic dissection.