449-P: Liraglutide Rapid Effects on Glucose and Adipose Tissue during and after CABG

Introduction: Optimization of glucose control during coronary artery by-pass grafting (CABG) is a major goal to reduce intra and post-op morbidity and mortality in subjects with coronary artery disease (CAD) and type 2 diabetes (T2DM). Glucagon like peptide-1 receptor analogs (GLP-1RAs) reduce cardiovascular risk. However, the short-term effects of GLP1RA on intra and post CABG metabolic control is unknown.

Objective: was to evaluate if pre-operative treatment with liraglutide can improve intra and post CABG glucose and metabolic control

Methods: This was a 12-week randomized, double-blind, placebo-controlled interventional study in 38 patients with T2DM and CAD with an acceptable glycemic control (HbA1c <8%) who required elective CABG. Subjects were started on either liraglutide or placebo in addition to current treatment for a minimum of 4 up to 12 weeks prior to CABG. Fat samples were collected during CABG; blood and clinical data were obtained before starting either liraglutide or placebo, intra-op and 1-month post-op.

Results: The two groups were very homogenous prior to the CABG. Patients who were randomized to liraglutide had significantly better intra-op glucose control during the CABG than those on placebo (146±21 vs 160±21 mg/dl, p<0.01). BMI and body weight significantly decreased at 1-month post-op when compared to baseline in patients who were randomized to liraglutide (from 32.7±6 to 30.5±5 kg/m²; from 214±39 to 208±38 lbs p< 0.05 for both), whereas placebo had no significant BMI or body weight changes. Post-op HbA1c improved in both liraglutide and placebo group (from 6.9 to 5.9% and from 7.2 to 6.1% respectively, p<0.01). Coronary epicardial fat (EAT) inflammatory transcriptome was significantly different than subcutaneous fat (p<0.01).

Conclusions: This RCT shows for the first time that short-term pre-CABG liraglutide induces significant beneficial cardio-metabolic effects, such as better intra- and post-operative glucose control, EAT changes and post-operative weight loss.