BACKGROUND: Patients undergoing transcatheter aortic valve replacement (TAVR) commonly have comorbid type 2 diabetes mellitus or obesity, both independently linked to adverse cardiovascular outcomes. GLP-1 receptor agonists (GLP-1 RAs) have shown cardiovascular benefits in these high-risk groups, however, 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 non-users and matched using 1:1 propensity score matching. The primary outcome was major adverse cardiovascular events (MACE), 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, 1,708 patients were included in each cohort. GLP-1 RA users were associated with significantly lower risks of the 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 non-users. Directionally consistent results were observed across subgroup analyses for the diabetes-only and obesity-only subgroups.
CONCLUSION: Among adults with diabetes mellitus or obesity undergoing TAVR, GLP-1 RA use was associated with significantly lower risks of several outcomes.
GLP-1 Therapies