Summary: In this 12-week double-blind, placebo-controlled randomised trial of 38 patients with type 2 diabetes and coronary artery disease awaiting coronary artery bypass grafting, pre-operative liraglutide was associated with better intra-operative glucose control than placebo (146 plus or minus 21 vs 160 plus or minus 21 mg/dL, p less than 0.01), independent of weight loss. The microRNAs miR16, miR155 and miR181a were higher in coronary and left atrial epicardial adipose tissue than in subcutaneous fat, a regional descriptive finding rather than a treatment effect on circulating levels.
PICO Summary
| Element | Detail |
|---|---|
| Population | 38 patients with type 2 diabetes and coronary artery disease scheduled for coronary artery bypass grafting (CABG); single-centre randomised controlled trial, United States. |
| Intervention | Liraglutide (GLP-1 receptor agonist) for a minimum of 4 and up to 12 weeks before CABG, with epicardial and subcutaneous fat sampled intra-operatively. |
| Comparison | Matching placebo over the same pre-operative window. |
| Outcome | Intra-operative glucose: 146 plus or minus 21 mg/dL (liraglutide) vs 160 plus or minus 21 mg/dL (placebo), p less than 0.01, independent of weight loss. miR16, miR155 and miR181a were higher in coronary epicardial (CORO-EAT) and left atrial epicardial (LA-EAT) fat than in subcutaneous fat (SAT) in the overall cohort (p less than 0.01 and p less than 0.05); in the liraglutide group miR16 and miR181a were higher in CORO-EAT vs SAT (p less than 0.01) and miR155 and miR181a higher in LA-EAT vs SAT (p less than 0.05). No 95% confidence intervals, absolute risk reduction or number needed to treat were reported. |
Expert Commentary
This small exploratory trial is best read as mechanistic and hypothesis-generating, not as evidence that liraglutide changes cardiac fat biology or surgical outcomes. The clearest signal is modestly better intra-operative glucose control on liraglutide, and the authors note this was independent of weight loss, which fits the drug’s known insulinotropic action. The microRNA data are descriptive comparisons between fat depots, showing that epicardial fat carries a distinct expression pattern from subcutaneous fat; they were not shown to be lowered by the drug, and the original framing of reduced circulating microRNAs overstated the result. The dominant limitation is sample size: with only 38 randomised patients across multiple depot and microRNA comparisons, the work is underpowered for any clinical endpoint and vulnerable to chance findings without correction for multiple testing. Can I use this with my patients? Not yet. Nothing here changes peri-operative management, and tighter glucose control around CABG is already standard care rather than a reason to start a GLP-1 receptor agonist. The trial was double-blind and placebo-controlled, which is a genuine strength, and no implausibly large effects were claimed. I would like to see an adequately powered trial with pre-specified glycaemic and cardiac endpoints before drawing any practice conclusions.
References
Iacobellis G, Goldberger JJ, Lamelas J, Martinez CA, Munoz Sterling C, Bodenstab M, Frasca D. Liraglutide effects on epicardial adipose tissue micro-RNAs and intra-operative glucose control. Nutr Metab Cardiovasc Dis. 2025;35(2):103726. doi:10.1016/j.numecd.2024.08.019