OBJECTIVE: Glucagon-like peptide 1 receptor agonists (GLP-1RAs) have shown to possess cardiovascular protective effects, with preclinical data, suggesting potential benefits in slowing abdominal aortic aneurysm (AAA) growth. However, their effect on AAA in humans remains underexplored. This study evaluates the effects of GLP-1RAs on all-cause mortality, AAA repair, and acute abdominal aortic syndrome in patients with unruptured AAA.
METHODS: We used the US collaborative network of the TriNetX platform to identify patients aged ≥18 years with unruptured AAA, based on International Classification of Disease, 10th Revision (ICD-10), codes from January 1, 2015, to March 1, 2020. Patients with prior AAA rupture, dissection, repair, and connective tissue disorders were excluded. The remaining cohort was stratified by type 2 diabetes (T2D) status and divided into two cohorts: patients who had GLP-1RA prescription within 6 months before or any time after their first AAA encounter diagnosis during the study period and non-GLP-1RA users who were never prescribed GLP-1RAs. Propensity score matching (1:1) adjusted for demographics, tobacco use, comorbidities, and medications. Five-year odds ratios (ORs) and Kaplan-Meier survival analyses assessed outcomes.
RESULTS: Of the 1407 patients prescribed GLP-1RAs and 38,994 not prescribed GLP-1RAs with T2D, 1401 patients were matched and analyzed. Similarly, among 336 patient prescribed GLP-1RAs and 129,790 not prescribed non-GLP-1RAs without T2D, 336 matched pairs were analyzed. Patient prescribed GLP-1RAs had significantly lower risks of the composite outcome of mortality, AAA repair, and acute abdominal aortic syndrome in both T2D (OR, 0.56; 95% confidence interval [CI], 0.47-0.66) and non-T2D cohorts (OR, 0.42; 95% CI, 0.28-0.63). Specifically, those prescribed GLP-1RAs had reduced mortality (T2D: OR, 0.54; 95% CI, 0.45-0.65; non-T2D: OR, 0.47; 95% CI, 0.30-0.74) and were less likely to undergo AAA repair (T2D: OR, 0.66; 95% CI, 0.45-0.95; non-T2D: OR, 0.45; 95% CI, 0.21-0.96). Kaplan-Meier analysis also demonstrated the benefits of GLP-1RAs in delaying outcome.
CONCLUSIONS: GLP-1RA prescriptions were associated with a lower risk of clinically important events in patients with unruptured AAA. These findings suggest potential benefits of GLP-1RAs in AAA management, warranting further research on their effect on aneurysm growth and progression.
