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GLP-1 Receptor Agonists Decrease The Rate Of Rupture, Cardiac Events, And Death In Patients With Abdominal Aortic Aneurysms
Catherine C. Go, MD, Frank Annie, PhD, Kerry Drabish, PhD, Mohammad H. Eslami, MD, MBA, MPH.
Charleston Area Medical Center, Charleston, WV, USA.
OBJECTIVES: Abdominal aortic aneurysm (AAA) is a degenerative condition involving several processes including inflammation, matrix remodeling, and disruptions of vascular smooth muscle cells leading to progressive dilatation of the aorta and eventual rupture. Glucagon-like peptide-1 receptor agonists (GLP-1RA) are now considered part of the frontline therapeutic options to treat type 2 diabetes mellitus and have also been validated as having compelling anti-inflammatory and cardiovascular protective properties. The aim of this study is to examine the effect of GLP-1RA on patients with AAA.
METHODS: Data was sourced from the TriNetX research network, encompassing 109 health care organizations. Utilizing ICD-10 and CPT codes, we identified patients with AAA who received abdominal imaging every six months. Group 1 was comprised of patients who were treated with GLP-1RA while Group 2 patients were not. Propensity-score-matching (PSM) was used in a 1:1 fashion using age, sex, smoking, hypertension, cardiac disease, and pulmonary disease as covariates. Primary outcomes were aneurysm rupture or repair. Secondary outcomes include mortality and major adverse cardiac events (MACE; myocardial infarction, stroke, and heart failure). Standard statistical methods were used as appropriate.
RESULTS: We identified 351,604 patients with AAA who were undergoing 6-month surveillance between January 1, 2010 and April 16, 2024. After PSM, each group included 10,127 patients. The average age for each group was 68 ± 9 years; roughly 68% of each group were men, 85% had diabetes, 92% had hypertension, 57% had coronary artery disease, and 30% had heart failure. There were no statistical differences between the groups. Group 1 exhibited significantly fewer ruptures (1.6% vs 2.3%, P<.01) and fewer elective repairs (1.9% vs 3.1%, P<.01) at five years when compared to Group 2. (See Figure) Group 1 experienced significantly fewer MACE and all-cause mortality at five years. On multivariate analysis, GLP-1RA significantly reduced the risk of rupture (HR 0.741, 95% CI [0.574-0.956], P=.021), MACE (HR 0.921, 95% CI [0.857-0.989], P=.024), and all-cause mortality (HR 0.697, 95% CI [0.620-0.785], P<.001).
CONCLUSIONS: The use of GLP-1RA in patients with AAA is associated with fewer ruptures, elective repairs, and improved rates of MACE and death.
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