Two ACR Convergence 2026 studies tie GLP-1 receptor agonists to lower cardiovascular and mortality risk.
GLP-1 receptor agonists and cardiovascular outcomes in veterans with rheumatologic diseases
Two real-world studies presented at the
Patients with rheumatologic diseases carry elevated cardiovascular risk from systemic inflammation, cardiometabolic comorbidity, and glucocorticoid use, and GLP-1 RAs reduce MACE in people with diabetes.² The American College of Rheumatology (ACR) highlighted both abstracts together, noting meeting abstract findings are preliminary and not yet peer reviewed.¹
Richa Purohit, MD, of the University of Central Florida, and colleagues used an active-comparator, new-user design to identify veterans with rheumatoid arthritis, systemic lupus erythematosus, or connective tissue disease who initiated a GLP-1 RA or DPP-4i between October 2005 and September 2021.² Propensity matching on 73 baseline characteristics yielded 2051 pairs, with a mean age of 66.8 years, 85.0% male, and a mean body mass index of 34.2 kg/m² in the GLP-1 RA group.²
The composite of MACE and all-cause death occurred in 20.0% (411/2051) of GLP-1 RA initiators vs 21.0% (430/2051) of DPP-4i initiators (hazard ratio [HR], 0.86; 95% CI, 0.76-0.99; P = .04).² Among patients losing more than 5% of baseline weight, the composite occurred in 22.9% vs 32.0% (HR, 0.71; 95% CI, 0.57-0.89; P = .003), with no benefit seen among those with lesser or no weight loss.²
Heart failure hospitalization (HR, 0.96; 95% CI, 0.72-1.28) and atrial fibrillation or flutter (HR, 1.01; 95% CI, 0.87-1.18) did not differ between groups.²
Weight loss after GLP-1 RA initiation and RAPID3 in RA and PsA
The second study, presented in Plenary Session I by Cristiano Moura and colleagues, identified 16,848 patients with rheumatoid arthritis or psoriatic arthritis receiving disease-modifying therapy who initiated semaglutide or tirzepatide between January 2018 and September 2024.³ Mean age was 57.9 years, 80.2% were female, and 67.3% had rheumatoid arthritis.³
Among 1880 patients with paired 12-month data, mean weight loss was 15.6 lb (standard deviation [SD], 19.2), and mean Routine Assessment of Patient Index Data 3 (RAPID3) score improved by 1.3 points (SD, 4.6).³ Each 5% decrease in body weight was associated with a 0.30-point RAPID3 reduction (95% CI, 0.18-0.42) and higher odds of a clinically meaningful RAPID3 improvement (adjusted odds ratio, 1.14; 95% CI, 1.07-1.21).³
Per 5% weight loss, pain scores fell by 0.19 points, patient global assessment by 0.12 points, and function by 0.04 points.³ Patients starting a new disease-modifying antirheumatic drug during follow-up were excluded.³
Both studies were observational, and the veterans cohort was predominantly male and limited to patients eligible for diabetes therapy. The weight loss subgroups in each analysis were defined by changes occurring after treatment began.
“Our findings suggest that GLP-1 receptor agonist treatment may be associated with clinically important reductions in serious cardiovascular events and death among veterans with rheumatologic conditions,” said Purohit.¹
“Importantly, GLP-1 receptor agonists may offer benefits that extend beyond weight loss alone, potentially through direct effects on inflammation and other biologic pathways relevant to rheumatic disease,” said Jeffrey Curtis, MD, MS, MPH, senior author of the RISE analysis, University of Alabama at Birmingham.¹
The RISE analysis was presented on November 8, 2026, as abstract 0867, and the veterans study will be presented on November 9, 2026, as poster 1784.²,³
