GLP-1 Receptor Agonists Offer Less Invasive Alternative to Bariatric Surgery for CV Health in Obese Patients | ACC 2025

Glucagon-Like Peptide 1 Receptor Agonists (GLP-1 RAs) may provide a more effective and less invasive alternative to bariatric surgery for improving cardiovascular (CV) outcomes in obese patients, according to a poster presentation titled “Cardiovascular Outcomes in Obese Patients Treated With GLP-1 RA vs. Bariatric Surgery: A Propensity-Matched Analysis” at the ACC.25 conference in Chicago this weekend.

Obesity is a chronic condition that increasingly raises the risk of cardiovascular disease (CVD).

Both bariatric surgery and GLP-1 Ras are commonly prescribed for weight loss and have been shown to improve cardiovascular outcomes.

According to the CDC, more than 100 million adults in the U.S. have obesity, including over 22 million with severe obesity.

The prevalence of obesity has surged from 30.5% in 1999 to 2000 to 41.9% in 2017, highlighting its growing impact on public health.

Obesity, or excess body weight, is a major global health concern, with high body mass index (BMI) linked to approximately 4 million deaths worldwide in 2015, according to an American Heart Association analysis.

The analysis found that more than two-thirds of these deaths were attributed to CVD, even after adjusting for risk factors such as smoking and other preexisting conditions.

In addition, CVD accounted for 41% of BMI-related deaths and 34% of BMI-related disability-adjusted life years.

To better understand differences in cardiovascular outcomes, researchers conducted a study comparing obese patients treated with GLP-1 RAs versus those undergoing bariatric surgery for weight loss.

The study identified obese patients who were receiving GLP-1 RAs and those undergoing bariatric surgery over the age of 18 using the TriNetX database from 2012 to 2021.

The study evaluated outcomes over a three-year period, including all-cause mortality, hospitalizations and CV adverse events.

Out of 189,248 patients, those in the GLP-1 RA group had significantly lower rates of acute myocardial infarction, all-cause hospitalization and all-cause mortality (odds ratio [OR]: 0.48, 95% confidence interval [CI]: 0.47-0.48) compared to the bariatric surgery group.

Also, the GLP-1 RA group demonstrated a reduced risk of cerebrovascular accidents (OR: 0.89, 95% CI: 0.86-0.93), acute heart failure and atrial fibrillation (OR: 0.74, 95% CI: 0.72-0.76) over the three-year follow-up period.

Aravinthan Vignarajah

Aravinthan Vignarajah, a specialist in internal medicine and postgraduate second-year resident at Cleveland Clinic and the study’s primary investigator, highlighted that while the findings are promising, further research is needed, particularly randomized controlled trials to confirm and determine the magnitude of the effect GLP-1 RAs have in comparison to bariatric surgery.

Vignarajah also noted that the study only included patients with a BMI of 30 or greater, with the average BMI being 41.4 in the GLP-1 RA group and 40.9 in the bariatric surgery group.

“Around 20% of the patients had diabetes, 38% had hypertension, and 27% had hyperlipidemia,” he said. “These findings suggest that GLP-1 RAs have potent beneficial effects for individuals with obesity, but based on other available studies, it is likely they offer even greater benefits for those with additional comorbidities like diabetes, hypertension, and lipid disorders.”

He further highlighted that GLP-1 RAs improve cardiovascular outcomes beyond weight loss, potentially due to their effects on glycemic control, blood pressure, lipid lowering, anti-inflammatory and anti-atherosclerotic properties, and possible direct effects on endothelial function and cardiac metabolism.

“These benefits are also observed with bariatric surgery, but it is likely that the effects are more pronounced in the GLP-1 RA group due to their impact on metabolism and inflammation,” he added.