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Background <p>Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have shown efficacy in reducing cardiovascular events in patients with diabetes mellitus (DM), but conflicting evidence exists regarding their impact on cardiac arrhythmias. Whereas some studies associated GLP-1RAs with arrhythmogenesis, other studies suggested a decreased association with atrial fibrillation (AF).</p> Objective <p>The aim was to compare the risk of incident AF after initiation of GLP-1RAs versus dipeptidyl peptidase-4 inhibitors (DPP4is), as active comparators, in patients with DM.</p> Design <p>A retrospective propensity score-matched cohort study was conducted.</p> Setting <p>The national data of Veterans Health Administration during fiscal years 2006–2021 were used for the study.</p> Patients <p>Adults who initiated either GLP-1RA or DPP4i medications were included.</p> Measurements <p>The primary outcome was a composite outcome of AF (diagnosis of AF/flutter or undergoing an AF procedure).</p> Results <p>Out of 116,235 GLP-1RA users and 217,668 DPP4i users, we propensity score-matched 80,948 pairs, on 88 characteristics. The composite outcome of AF was similar in the GLP-1RA group (4.1%) and DPP4i group (4.3%); odds ratio (OR) 0.96, 95% confidence interval (CI) 0.92–1.01. Secondary analyses stratified by medication use duration showed no significant differences in composite AF risk (<i>p</i> &gt; 0.05). Individuals achieving 5% weight loss from baseline body weight had significantly lower AF incidence (OR 0.83, 95% CI 0.78–0.89), whereas no significant differences were observed in those with no weight loss or weight gain (OR 1.05, 95% CI 0.97–1.12).</p> Conclusions <p>GLP-1RA use was not associated with a decreased or increased risk of AF compared to DPP4i&#xa0;use. In subgroup analysis, lower AF risk was seen in GLP-1RA versus DPP4i users who achieved weight loss, which suggests weight loss as a potential modifier of response to GLP-1RAs.</p>

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Association of Glucagon-Like Peptide-1 Receptor Agonist with Incident Atrial Fibrillation

  • 期刊论文

  • 发表日期：

    2025年7月19日

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  • Suzan Khalil,
  • William Hicks,
  • Floyd W. Burke,
  • Ishak A. Mansi

摘要

Background

Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have shown efficacy in reducing cardiovascular events in patients with diabetes mellitus (DM), but conflicting evidence exists regarding their impact on cardiac arrhythmias. Whereas some studies associated GLP-1RAs with arrhythmogenesis, other studies suggested a decreased association with atrial fibrillation (AF).

Objective

The aim was to compare the risk of incident AF after initiation of GLP-1RAs versus dipeptidyl peptidase-4 inhibitors (DPP4is), as active comparators, in patients with DM.

Design

A retrospective propensity score-matched cohort study was conducted.

Setting

The national data of Veterans Health Administration during fiscal years 2006–2021 were used for the study.

Patients

Adults who initiated either GLP-1RA or DPP4i medications were included.

Measurements

The primary outcome was a composite outcome of AF (diagnosis of AF/flutter or undergoing an AF procedure).

Results

Out of 116,235 GLP-1RA users and 217,668 DPP4i users, we propensity score-matched 80,948 pairs, on 88 characteristics. The composite outcome of AF was similar in the GLP-1RA group (4.1%) and DPP4i group (4.3%); odds ratio (OR) 0.96, 95% confidence interval (CI) 0.92–1.01. Secondary analyses stratified by medication use duration showed no significant differences in composite AF risk (p > 0.05). Individuals achieving 5% weight loss from baseline body weight had significantly lower AF incidence (OR 0.83, 95% CI 0.78–0.89), whereas no significant differences were observed in those with no weight loss or weight gain (OR 1.05, 95% CI 0.97–1.12).

Conclusions

GLP-1RA use was not associated with a decreased or increased risk of AF compared to DPP4i use. In subgroup analysis, lower AF risk was seen in GLP-1RA versus DPP4i users who achieved weight loss, which suggests weight loss as a potential modifier of response to GLP-1RAs.