Frontiers in Cardiovascular Medicine · Oct 30, 2026
Association of GLP-1 Receptor Agonist Use With Echocardiographic Pulmonary Pressure and Right Ventricular Function in Type 2 Diabetes: A Retrospective Cohort Study
By ARIF ALBULUSHI, Shabib Al-Asmi, Khalid Al-Saidi et al.
Background: Pulmonary hypertension (PH) and right ventricular (RV) dysfunction are increasingly recognized in type 2 diabetes. GLP-1 receptor agonists (GLP-1 RAs) may favorably influence cardiometabolic and vascular pathways, but clinical data on pulmonary pressure and RV function remain limited. Objective: To evaluate the association between GLP-1 RA use and echocardiographic pulmonary pressure, RV systolic function, and RV–pulmonary arterial coupling in adults with type 2 diabetes. Methods: We conducted a retrospective cohort study of 1,200 adults with type 2 diabetes who underwent transthoracic echocardiography between 2015 and 2025, including 600 GLP-1 RA users and 600 non-users. Primary outcomes were right ventricular systolic pressure (RVSP) and tricuspid annular plane systolic excursion (TAPSE). Secondary outcomes included RVSP >35 mmHg, RV systolic dysfunction, and TAPSE/sPAP. Multivariable regression adjusted for relevant demographic, cardiometabolic, clinical, and treatment variables. An exploratory analysis assessed outcomes according to GLP-1 RA exposure duration (<12 vs ≥12 months). Results: Median GLP-1 RA exposure was 14.4 months (IQR 8.5–22.6). GLP-1 RA use was independently associated with lower RVSP (adjusted β −0.96 mmHg; 95% CI −1.66 to −0.26; P=0.007), higher TAPSE (adjusted β 0.080 cm; 95% CI 0.046–0.114; P<0.001), and higher TAPSE/sPAP (adjusted β 0.035 mm/mmHg; 95% CI 0.021–0.049; P<0.001). RV systolic dysfunction was less frequent among GLP-1 RA users (adjusted OR 0.58; 95% CI 0.41–0.81; P=0.001), while the association with RVSP >35 mmHg was not significant (adjusted OR 0.85; 95% CI 0.67–1.09; P=0.212). In exploratory analyses, exposure ≥12 months was associated with lower RVSP, higher TAPSE, and higher TAPSE/sPAP compared with non-use, whereas associations were weaker and non-significant with <12 months exposure. Manuscript Conclusion: GLP-1 RA use was associated with modestly lower RVSP, better RV systolic function, and more favorable RV–pulmonary arterial coupling, with stronger associations observed after ≥12 months of exposure. These observational findings are hypothesis-generating and do not establish causality.