For most people, GLP-1 drugs are associated with diabetes and weight loss. But their potential benefits may go much further.
Researchers found that people taking GLP-1 receptor agonists before elective surgery were less likely to experience serious cardiovascular complications or postoperative infections than those who were not using the drugs.
Josephine Tolan, MD, the study's lead author, told Newsweek she was particularly struck by the size of the associations, with GLP-1 use linked to an 11 percent reduction in the odds of major cardiovascular events and an 8 percent reduction in the odds of postoperative infections.
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"These findings are particularly interesting because GLP-1 medications are best known for their metabolic benefits," Tolan said. "Beyond their effects on appetite and satiety, these drugs may also modulate inflammatory pathways, which could help explain the associations we observed."
She added that it was especially interesting to see the associations persist around the time of surgery, "when surgery typically triggers a substantial inflammatory response."
Researchers at McGovern Medical School at UTHealth Houston set out to examine whether GLP-1 use could influence two major risks following surgery: cardiovascular complications and infections.
GLP-1 receptor agonists, a class of medications that includes semaglutide and tirzepatide-based treatments, were originally developed to help manage blood sugar in people with type 2 diabetes.
In recent years, studies have also linked them to reduced risks of major cardiovascular events, but their effects around the time of surgery have remained unclear.
Millions included in the research
To investigate, researchers analyzed data from the EPIC COSMOS database, a large electronic health record system that aggregates information from more than 1,700 hospitals and 40,000 clinics.
The study included 2,028,601 adults who underwent elective surgeries lasting longer than an hour and required at least 24 hours of hospitalization between January 2016 and December 2024.
Of those patients, 145,610 were receiving GLP-1 therapy. After using statistical matching techniques to create comparable groups, the researchers examined rates of major adverse cardiovascular events, known as MACE, and infections following surgery.
MACE included heart attack, myocardial injury, stroke and death from any cause. Infection outcomes included surgical site infections, urinary tract infections, pneumonia and sepsis.
The analysis found that major cardiovascular events occurred in 1 percent of GLP-1 users, compared with 1.1 percent of non-users.
Meanwhile, postoperative infections affected 4.9 percent of GLP-1 users and 5.3 percent of non-users.
Overall, GLP-1 use was associated with an 11 percent reduction in the odds of major cardiovascular complications and an 8 percent reduction in the odds of postoperative infections.
Concern about effect on preop fasting
However, the findings also enter an ongoing discussion over how GLP-1 medications should be managed before surgery.
Tolan said one concern for anesthesiologists is that the drugs delay gastric emptying, potentially leaving residual stomach contents despite standard fasting and increasing the risk of aspiration during anesthesia.
"Our findings do not eliminate that concern," Tolan said. "But they do raise the possibility that continuing these medications could improve postoperative outcomes."
Tolan said current U.S. guidance favors an individualized approach rather than routinely withholding GLP-1 medications from every patient before surgery.
Further research is needed to establish whether the apparent benefits are causal and how best to balance them against aspiration risk, she added.
The researchers said the findings point to a potentially important perioperative benefit of GLP-1 medications, which could help improve outcomes for patients undergoing non-cardiac elective surgery.
No proof of direct cause
However, they cautioned that the study was observational and cannot prove that the drugs directly caused the reductions in risk.
Dr. Jessica Duncan, chief medical officer at Ivím Health and a board-certified obesity medicine physician, told Newsweek that while the study's size and real-world scope make the findings meaningful, the absolute differences between the two groups were relatively small.
"For an individual patient, that may be a small benefit, but across the millions of surgeries performed each year, it could be clinically relevant," she said.
She said the results are biologically plausible because GLP-1 medications improve blood sugar control, have anti-inflammatory effects and have demonstrated cardiovascular benefits in randomized controlled trials.
The study, she added, provides early evidence that some of those benefits may persist around surgery.
However, Duncan stressed that the observational design means cause and effect cannot be established.
The research also did not establish whether or when patients stopped taking GLP-1 medication before surgery, making it impossible to determine whether the association resulted from having the drug active during surgery or from its longer-term metabolic effects.
Don't change GLP-1 plan just yet
The study also focused on inpatient surgery and did not report aspiration outcomes, meaning it "informs the potential benefit, but not the full risk picture," Duncan said.
For patients, Duncan said the findings should not prompt anyone to start or stop a GLP-1 medication without medical guidance.
Instead, patients should tell their surgical and anesthesia teams which GLP-1 they are taking, their dosage and when they last took it, and follow their clinicians' instructions.
For doctors, she said the findings may support a move toward individualized decisions about GLP-1 use before surgery, but do not justify starting the drugs specifically to prevent surgical complications.
"Ultimately, this study is reassuring and hypothesis-generating," Duncan said. "The next step is prospective research that evaluates benefit and risk together, so we can define which patients benefit most and how these medications should be managed around surgery."