Celestino Sardu, Ludovica Vittoria Marfella, Carlo Fumagalli, Luca Rinaldi, Ferdinando Carlo Sasso, Domenico Cozzolino, Francesco Nappo, Ausilia Sellitto, Ciro Romano, Caterina Carusone, Pasquale Russo, Lorenza Marfella, Nicola Tarantino, Gerardo Carpinella, Fulvio Furbatto, S Gentile, Giuseppina Guarino, Ersilia Satta, Alessandro Bellis, Luca Marinelli, Isabella Donisi, Nunzia D’Onofrio, Ciro Mauro, Salvatore Cappabianca, Maria Luisa Balestrieri, Raffaele Marfella
The aim was to assess the impact of glucagon-like peptide-1 receptor agonists (GLP-1 RA) treatment on the progression of ascending aorta dilatation in patients with type 2 diabetes mellitus (T2DM). A total of 127 T2DM patients with subclinical ascending aortic dilatation (35–45 mm) were prospectively enrolled. Fifty-seven initiated GLP-1 RA therapy (liraglutide, semaglutide, or dulaglutide), while 70 continued on standard care. Ascending aortic diameter was measured by computed tomography angiography (CTA) at baseline and 24 months, alongside circulating markers of vascular remodeling: matrix metalloproteinase-9 (MMP-9), tissue inhibitor of metalloproteinases-1 (TIMP-1), C-reactive protein (CRP), and osteoprotegerin (OPG). Progression of aortic dilatation was significantly lower in the GLP-1 RA group compared with controls (+0.36 ± 0.20 mm vs. +1.05 ± 0.28 mm; p < 0.001). Therapy correlated with decreased MMP-9 and CRP (p < 0.01) and increased TIMP-1 and OPG (p < 0.05). The use of GLP-1 RA was an independent predictor of low progression, even in multivariate models after adjusting for demographic, metabolic, and biomarker data. GLP-1 RA therapy was associated with reduced progression of ascending aortic dilatation in T2DM, supporting a potential vasoprotective role beyond glucose lowering.