# Glucagon-Like Peptide-1 (GLP-1) Agents and Cardiovascular Risk in Non-diabetic Patients: A Descriptive Analysis of National Health and Nutrition Examination Survey (NHANES), 2011–2018

## TL;DR

This study found no use of GLP-1 agents among obese non-diabetic adults in the U.S. between 2011 and 2018, highlighting the need for updated data on their real-world adoption and outcomes.

## Contribution

The study provides baseline cardiovascular risk and mortality data in obese non-diabetic adults before GLP-1 RA adoption.

## Key findings

- No GLP-1 RA use was reported among 6,065 obese non-diabetic adults in the NHANES 2011–2018 data.
- Approximately 3.8% of participants died from any cause, and 1.1% from cardiovascular causes during follow-up.
- The findings emphasize the need for more recent data to assess GLP-1 RA adoption and outcomes in this population.

## Abstract

Background: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have demonstrated cardiovascular benefit in patients with type 2 diabetes and, more recently, in obese adults without diabetes. However, real-world uptake of these agents during their early introduction remains unclear. The objective of this study was to describe the prevalence of GLP-1 RA use and provide baseline, pre-uptake, population-level estimates of major adverse cardiovascular events (MACE, including myocardial infarction, stroke, and cardiovascular death) and mortality among obese adults without diabetes, in the United States (US), using pooled National Health and Nutrition Examination Survey (NHANES) 2011-2018 data.

Methods: We analyzed adults aged ≥20 years with measured obesity (BMI ≥30 kg/m²) who did not meet criteria for diabetes in NHANES 2011-2018 (unweighted n = 6,065, representing a weighted US population of ≈69 million). Medication use was ascertained from the prescription drug questionnaire (medications taken in the prior 30 days). Baseline demographics, anthropometrics, and cardiometabolic risk factors are reported as survey-weighted estimates. Mortality (all-cause and cardiovascular) was ascertained via linkage to the 2019 National Death Index.

Results: Among 6,065 obese, non-diabetic adults, none reported GLP-1 RA use in the 30 days preceding survey participation. The mean age was 45.9 years, and the mean body mass index was 35.7 kg/m². The cohort included 37,127,528 (53.6%) female and 44,259,809 (63.9%) non-Hispanic White participants. Hypertension was reported by 25,745,249 (37.2%), and 29,749,000 (42.9%) had smoked ≥100 cigarettes. Over follow-up, 2,661,169 (3.8%) of participants died from any cause, and 786,635 (1.1%) from cardiovascular causes. Because no GLP-1 RA users were identified, comparative (adjusted odds) analyses were not possible.

Conclusion: In NHANES 2011-2018, GLP-1 RA use among obese US adults without diabetes was absent, reflecting minimal community uptake in this period. These survey-weighted estimates provide baseline, pre-uptake cardiovascular and mortality benchmarks and emphasize the need for analyses using more recent data to evaluate real-world GLP-1 adoption and outcomes.