New research presented at the European Congress on Obesity (ECO) 2025 suggests that medications like semaglutide and liraglutide significantly reduce the risk of heart attacks, strokes, and other major cardiovascular events in adults with obesity and type 2 diabetes who fail to achieve adequate weight loss and blood sugar control after bariatric surgery.
The retrospective cohort study, based on real-world data, found that patients who received glucagon-like peptide-1 receptor agonists (GLP-1RAs) following bariatric surgery experienced a 67% reduction in the risk of major adverse cardiovascular events (MACE) or death from any cause, compared to those who underwent surgery alone.
“These findings provide critical early clinical insights,” said Professor Orna Reges, co-lead author from Ariel University and Clalit Health Services, Israel. “In real-life settings, individuals with obesity and diabetes are at heightened cardiovascular risk. This study indicates that adding GLP-1RAs post-surgery could help sustain weight loss and glycemic control, thereby reducing long-term cardiovascular risks.”
GLP-1RAs, typically administered via weekly injections, mimic natural incretin hormones that lower blood sugar after meals and promote satiety by slowing digestion, leading to reduced food intake. While the benefits of both bariatric surgery and GLP-1RAs in managing obesity, diabetes, and cardiovascular risk are well-established separately, their combined impact post-surgery on primary cardiovascular prevention had remained unclear until now.
To bridge this knowledge gap, researchers analyzed electronic health records from Clalit Health Services, covering over half of Israel’s population (around 4.8 million). The study focused on adults aged 24 and older with a body mass index (BMI) of 30 kg/m² or higher, who underwent bariatric surgery between 2008 and 2018. Among these, 822 participants (72% women, average age 58) with no prior heart disease history and no GLP-1RA use before surgery were included.
Each patient who initiated GLP-1RA therapy post-surgery was matched with a counterpart who had surgery alone, aligning factors such as age, sex, BMI, and time since surgery. Participants were monitored until December 2023 to assess changes in BMI, blood glucose levels, and the occurrence of MACE or death.
Over an average follow-up of 1.7 years, 18 patients experienced either a MACE or death. Among surgery-only patients, 13 out of 411 (3.2%) encountered these outcomes, compared to just 5 out of 411 (1.2%) in the GLP-1RA group—indicating a striking 67% relative risk reduction.
The study also noted that while GLP-1RA patients initially had higher weight and blood sugar levels post-surgery, these metrics improved over time, eventually matching those of patients who succeeded with surgery alone.
Despite the promising results, the authors caution that the study’s relatively small sample size limits the generalizability of the findings. “This is an important first phase, offering real-world data on GLP-1RA use in patients with suboptimal surgical outcomes,” Professor Reges said. “The next phase will apply a target trial emulation approach to validate and expand upon these findings.”
Co-lead author Professor Dror Dicker from Hasharon Hospital, Rabin Medical Center, added, “These results contribute to the mounting evidence of the cardiovascular benefits of GLP-1RAs. However, larger and more rigorous clinical trials are essential to establish the safety, effectiveness, and optimal timing of GLP-1RA therapy post-bariatric surgery.”
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