Association of GLP-1 Receptor Agonists Versus Bariatric Surgery with Outcomes in Obese Patients with Hypertrophic Cardiomyopathy: A Multicenter Propensity-Matched Analysis

Mar 30, 2026European heart journal. Quality of care & clinical outcomes

Comparing Weight-Loss Drugs and Surgery Outcomes in Obese Patients with Thickened Heart Muscle

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Abstract

Among 5,002 patients, GLP-1 receptor agonist therapy was associated with lower all-cause mortality compared to bariatric surgery (2.0% vs 4.4%).

GLP-1 receptor agonists were linked to a 54% reduction in all-cause mortality risk compared to bariatric surgery.
The incidence of heart failure hospitalization was 8.7% in the GLP-1 RA group versus 14.0% in the bariatric surgery group.
Composite cardiovascular outcomes occurred in 10.7% of patients receiving GLP-1 RA compared to 17.2% in those who underwent bariatric surgery.
Rates of arrhythmias and cardiovascular symptoms showed no significant differences between the two treatment groups.
Bariatric surgery resulted in a greater reduction in body mass index compared to GLP-1 RA treatment.

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BACKGROUND: Obesity is linked with worse outcomes in hypertrophic cardiomyopathy (HCM). While both bariatric surgery (BS) and GLP-1 receptor agonists (GLP-1RA) promote weight loss and may improve cardiometabolic risk, their comparative outcomes in HCM remains unclear.

METHODS: Adults with HCM and BMI ≥ 30 kg/m², divided into 2 cohorts: 1) GLP-1 RA users who never had BS and 2) BS patients who never received GLP-1 RA. Propensity score matching (1:1) was performed to balance demographics, comorbidities, and medications. Outcomes over 24-month: all-cause mortality, acute heart failure (HF) hospitalization, arrhythmias, change in BMI, and cardiovascular symptoms. Hazard ratios with 95% confidence intervals were estimated using Cox models.

RESULTS: Of 5,002 patients, 955 were included in each matched cohort after matching (mean age 54 ± 13 years, 70% female, BMI 40.0 kg/m²). GLP-1 RA was associated with a significantly lower observed rates of all-cause mortality compared with BS (2.0% vs 4.4%; HR 0.46; 95% CI 0.27-0.80; p = 0.004) and HF hospitalization (8.7% vs 14.0%; HR 0.60; 95% CI 0.46-0.79; p < 0.001). Similarly, GLP-1 RA use was associated with lower incidence of composite cardiovascular outcomes (10.7% vs 17.2%; HR 0.60; 95% CI 0.47-0.77; p < 0.001). Rates of arrhythmias, and cardiovascular symptoms were comparable between the two groups. BMI reduction was greater after bariatric surgery (-4.0 vs -2.6 kg/m²; p < 0.001).

CONCLUSIONS: In obese patients with HCM, GLP-1 RA therapy was associated with lower all-cause mortality and fewer HF events compared with BS. Future studies are warranted to confirm our findings.

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Association of GLP-1 Receptor Agonists Versus Bariatric Surgery with Outcomes in Obese Patients with Hypertrophic Cardiomyopathy: A Multicenter Propensity-Matched Analysis

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