Glucagon-like peptide-1 receptor agonists and the risk of atrial fibrillation in adults with diabetes: a real-world study.
J Gen Intern Med
; 39(7): 1112-1121, 2024 May.
Article
in En
| MEDLINE
| ID: mdl-38191976
ABSTRACT
BACKGROUND:
Glucagon-like peptide-1 receptor agonists (GLP-1RA) have cardiovascular benefits in type 2 diabetes, but none of the cardiovascular trials studied atrial fibrillation/atrial flutter (AF) as a primary endpoint. Data from post-marketing surveillance studies remains sparse.OBJECTIVE:
To examine the real-world risk of AF comparing GLP-1RA with other non-insulin glucose-lowering agents.DESIGN:
Cohort study using de-identified electronic health record data from the Optum Labs Data Warehouse.PARTICIPANTS:
Adult patients with diabetes who were newly prescribed add-on non-insulin glucose-lowering agents and were on metformin between 2005-2020. EXPOSURES New users of GLP-1RA were separately compared with new users of dipeptidyl peptidase-4 inhibitors (DPP4i) and sodium-glucose cotransporter 2 inhibitors (SGLT2i), using 11 propensity score matching to adjust for differences in patient characteristics. MAINMEASURES:
The primary outcome was incident AF, defined and captured by diagnosis code for AF. Incidence rate difference (IRD) and hazard ratio (HR) were estimated in the matched cohorts. KEYRESULTS:
In the matched cohort of 14,566 pairs of GLP-1RA and DPP4i followed for a median of 3.8 years, GLP-1RA use was associated with a lower risk of AF (IRD, -1.0; 95% CI, -1.8 to -0.2 per 1000 person-years; HR, 0.82; 95% CI, 0.70 to 0.96). In the matched cohort of 9,424 pairs of patients on GLP-1RA and SGLT2i with a median follow-up of 2.9 years, there was no difference in the risk for AF (IRD, 0.4; 95% CI -0.7 to 1.5 per 1000 person-years; HR, 1.12; 95% CI, 0.89 to 1.42).CONCLUSIONS:
In this real-word study, GLP-1RA was associated with a lower risk of AF compared with DPP4i, but no difference compared with SGLT2i, suggesting that cardiovascular benefits of GLP-1RA use may extend to prevention for AF in patients with diabetes. Our findings call for future randomized controlled trials to focus on the effects of GLP-1RA on AF prevention.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Atrial Fibrillation
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Diabetes Mellitus, Type 2
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Dipeptidyl-Peptidase IV Inhibitors
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Glucagon-Like Peptide-1 Receptor
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Hypoglycemic Agents
Type of study:
Clinical_trials
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Etiology_studies
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Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limits:
Adult
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Aged
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Female
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Humans
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Male
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Middle aged
Language:
En
Journal:
J Gen Intern Med
/
J. gen. intern. med
/
Journal of general internal medicine
Journal subject:
MEDICINA INTERNA
Year:
2024
Document type:
Article
Affiliation country:
United States
Country of publication:
United States