ArticleObesity facts2026
Initiation of GLP-1 Receptor Agonists Treatment after Bariatric Metabolic Surgery and Major Adverse Cardiac Events.
Article in Obesity facts, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
introductionBariatric metabolic surgery (BMS) alone or glucagon-like peptide-1 receptor agonists (GLP-1RA) alone are known to reduce major adverse cardiovascular events (MACEs). However, the benefit for primary prevention of MACE with use of GLP-1RA treatment after BMS is unclear. This retrospective cohort study assessed the associations of post-BMS GLP-1RA treatment with first incidence of MACE/all-cause mortality, as well as with predicted cardiovascular (CVD) risk and body mass index (BMI) and hemoglobin-A1c (HbA1c) levels, among patients with obesity and diabetes.
methodsAdults who initiated GLP-1RA post-BMS were compared with individuals who did not. Groups were matched based on age, sex, BMI, HbA1c, years since BMS, and the nearest-neighbor propensity score for the probability of receiving GLP-1RA. Follow-up began at GLP-1RA initiation and ended on December 31, 2023.
resultsThe study population included 476 GLP-1RA initiators and 952 matched BMS-only patients (mean [SD] age: 48.7 [9.5] years; 1,046 [73.2%] women). GLP-1RA initiation after BMS was associated with reduction in BMI (-7.0%) and HbA1c (-13.0%) and higher diabetes remission (78.0% vs. 61.6%). Ten-year predicted CVD risk was similar between users and nonusers before treatment initiation (0.053%) but was significantly lower among users during follow-up (0.039% vs. 0.046%). During a mean (SD) follow-up of 1.4 (0.8) years (maximum ∼10.6 years), there were 12.7 per 1,000 person months (n = 17) and 10.6 per 1,000 person months (n = 7) new cases of MACE and all-cause mortality in the BMS-only and GLP-1RA post-BMS group, respectively. No overall statistically significant association was observed between initiation of GLP-1RA after BMS and MACE/all-cause mortality. However, significant interaction was observed with time since BMS (p = 0.04), with a lower risk of MACE/all-cause mortality as the time from BMS increased.
conclusionInitiation of GLP-1RAs after BMS was associated with lower BMI and HbA1c levels, higher diabetes remission, and reduced predicted CVD risk among patients with diabetes and obesity. Overall, GLP-1RA treatment after BMS did not further reduce the risk of MACE/all-cause mortality compared to BMS alone after a mean follow-up of 1.4 years. Given the observed time-dependent benefit of treatment after BMS, longer follow-up studies are needed to determine the optimal timing for initiation.
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