Glucagon-like peptide-1 receptor agonists and the risk of atrial fibrillation in adults with diabetes: a real-world study

Jan 9, 2024Journal of general internal medicine

Glucagon-like peptide-1 drugs and the risk of irregular heartbeat in adults with diabetes: a real-world study

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Abstract

In a matched cohort of 14,566 pairs, GLP-1 receptor agonist use was associated with a lower risk of atrial fibrillation compared to dipeptidyl peptidase-4 inhibitors.

GLP-1 receptor agonists were linked to an incidence rate difference of -1.0 per 1000 person-years for atrial fibrillation when compared to DPP4 inhibitors.
The hazard ratio for atrial fibrillation in patients using GLP-1 receptor agonists versus DPP4 inhibitors was 0.82, indicating a reduced risk.
In a separate cohort of 9,424 pairs, there was no significant difference in atrial fibrillation risk between GLP-1 receptor agonists and sodium-glucose cotransporter 2 inhibitors.
The incidence rate difference for atrial fibrillation when comparing GLP-1RA to SGLT2i was 0.4 per 1000 person-years, with a hazard ratio of 1.12.

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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 1:1 propensity score matching to adjust for differences in patient characteristics.

MAIN MEASURES: 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.

KEY RESULTS: 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.

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Glucagon-like peptide-1 receptor agonists and the risk of atrial fibrillation in adults with diabetes: a real-world study

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