The Canadian journal of cardiology · 2026
Cardiovascular Outcomes With GLP-1 Receptor Agonists in Patients With Diabetes or Obesity Undergoing Transcatheter Aortic Valve Replacement.
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Goyal Aman, Saeed Humza, Jain Hritvik, Hurjkaliani Sonia, Mahalwar Gauranga, Jaiswal Vikash, Ricciardi Mark J, Kolte Dhaval, Fonarow Gregg C, Piazza Gregory, Kapadia Samir, Qamar Arman
Аннотация
BACKGROUND: Patients undergoing transcatheter aortic valve replacement (TAVR) commonly have comorbid type 2 diabetes mellitus or obesity, both independently linked to adverse cardiovascular outcomes. Glucagon-like protein-1 receptor agonists (GLP-1 RAs) have shown cardiovascular benefits in these high-risk groups, but their utility in patients undergoing TAVR remains understudied.
METHODS: We conducted a retrospective cohort study using the TriNetX database (2020-2025) to identify adults with type 2 diabetes mellitus or obesity undergoing TAVR. Patients were categorized as GLP-1 RA users or nonusers and matched using 1:1 propensity-score matching. The primary outcome was major adverse cardiovascular events (MACEs), defined as a composite of all-cause mortality, acute myocardial infarction, stroke, and heart failure exacerbation. Secondary outcomes included individual components and new-onset atrial fibrillation/flutter.
RESULTS: After matching, 1708 patients were included in each cohort. GLP-1 RA users were associated with significantly lower risk of MACE (hazard ratio [HR] 0.63, 95% confidence interval [CI] 0.57-0.70, P < 0.001), all-cause mortality (HR 0.61, 95% CI 0.48-0.78, P < 0.001), acute myocardial infarction (HR 0.71, 95% CI 0.57-0.89, P = 0.002), stroke (HR 0.74, 95% CI 0.59-0.94, P = 0.011), heart failure exacerbation (HR 0.38, 95% CI 0.32-0.44, P < 0.001), and new-onset atrial fibrillation/flutter (HR 0.60, 95% CI 0.44-0.84, P = 0.002) compared with nonusers. Directionally consistent results were observed across subgroup analyses for the diabetes-only and obesity-only subgroups.
CONCLUSIONS: Among adults with diabetes mellitus or obesity undergoing TAVR, GLP-1 RA use was associated with significantly lower risks of several outcomes.
METHODS: We conducted a retrospective cohort study using the TriNetX database (2020-2025) to identify adults with type 2 diabetes mellitus or obesity undergoing TAVR. Patients were categorized as GLP-1 RA users or nonusers and matched using 1:1 propensity-score matching. The primary outcome was major adverse cardiovascular events (MACEs), defined as a composite of all-cause mortality, acute myocardial infarction, stroke, and heart failure exacerbation. Secondary outcomes included individual components and new-onset atrial fibrillation/flutter.
RESULTS: After matching, 1708 patients were included in each cohort. GLP-1 RA users were associated with significantly lower risk of MACE (hazard ratio [HR] 0.63, 95% confidence interval [CI] 0.57-0.70, P < 0.001), all-cause mortality (HR 0.61, 95% CI 0.48-0.78, P < 0.001), acute myocardial infarction (HR 0.71, 95% CI 0.57-0.89, P = 0.002), stroke (HR 0.74, 95% CI 0.59-0.94, P = 0.011), heart failure exacerbation (HR 0.38, 95% CI 0.32-0.44, P < 0.001), and new-onset atrial fibrillation/flutter (HR 0.60, 95% CI 0.44-0.84, P = 0.002) compared with nonusers. Directionally consistent results were observed across subgroup analyses for the diabetes-only and obesity-only subgroups.
CONCLUSIONS: Among adults with diabetes mellitus or obesity undergoing TAVR, GLP-1 RA use was associated with significantly lower risks of several outcomes.