The Role of GLP-1 Drugs in the Treatment of PAD

An Interview With Ian Del Conde, MD, FACC, FSVM

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VASCULAR DISEASE MANAGEMENT. 2025;22(3):E20-E21

In a session on New Horizons in Endovascular Therapy at ISET 2025, Ian Del Conde, MD, FACC, FSVM, a cardiologist and vascular medicine specialist at the Miami Cardiac & Vascular Institute, gave a presentation entitled “Role of GLP-1 Drugs in the Treatment of PAD”. GLP-1 receptor agonists, such as semaglutide (Ozempic, Wegovy) and tirzepatide (Mounjaro, Zepbound), have been shown to reduce HbA1c and body weight in patients with diabetes, and now show promise in improving cardiovascular disease. Vascular Disease Management spoke with Dr Del Conde about his presentation, where he recommended that every patient with peripheral arterial disease (PAD) should be considered for GLP-1 therapy if they have diabetes mellitus and a body mass index over 27. 

Dr Del Conde, tell us about your talk on GLP-1 receptor agonists that you are presenting at ISET this year.

GLP-1 receptor agonists have been available for clinical use for quite some time, so they are not new, but there was a significant change recently. When these drugs were developed, they were short-acting and primarily focused on the management of patients with diabetes. Then a few years ago, the molecule in some of these agents was modified to make them very long-acting. What we learned was that the pharmacological effects really changed; one of the effects that was very clear was significant weight loss, and that is one of the things that has made this new class of medications a real hot topic. But it turns out that even beyond weight loss, they have a number of effects that are tremendously beneficial.

In addition to controlling diabetes better, they have a pretty significant impact on cardiovascular outcomes. Patients enrolled in GLP-1 trials have been observed to have a lower risk of heart attacks and strokes compared to patients receiving the usual standard of care. This has led to a number of ongoing trials looking specifically at the effect of these medications on patients with PAD, who are a subgroup of patients with cardiovascular disease at the highest risk of cardiovascular events.

Patients with PAD typically have diffuse disease all over the body and an increased risk compared to other patients with cardiovascular disease. There appears to be a very, very strong signal that these patients particularly benefit from GLP-1 therapies, especially if they are diabetic and/or overweight. 

Do you recommend that patients with PAD be treated with GLP-1 therapies?

I think it is fair to say that with our current knowledge, if you think about the optimal medical management of a patient with PAD, you have to think about GLP-1 receptor agonists. You have to think about these medications as being part of the essential cocktail that these patients should be receiving—not because of the weight loss aspect but because of the tremendous cardiovascular protection they provide.

There are ongoing trials looking at PAD and if the ability for these patients to walk is improved. There are some smaller studies showing that just these medications improve blood flow to the legs. The mechanism behind that is being researched, but it may have to do with vasodilation and less inflammation. With fewer symptoms in the legs, there is a lower risk of amputation. Nobody really expected any of this, but it is very powerful. GLP-1 receptor agonists are approved now in patients with cardiovascular disease and diabetes as well as cardiovascular disease and obesity because you really lower the cardiovascular events with these medications. n