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GLP-1RA may have varying effects on cardiac structure in patients with ASCVD depending on BMI
1Department of Cardiology, Peking University Third Hospital, NHC Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Peking University, Beijing, China.
Insights
Glucagon-like peptide-1 receptor agonists (GLP-1RA) show varied cardiovascular benefits based on patient BMI. While obese patients experience weight loss and ventricular improvements, normal-weight individuals may see direct atrial remodeling benefits from GLP-1RA.
Area of Science:
- Cardiology
- Endocrinology
- Pharmacology
Background:
- Glucagon-like peptide-1 receptor agonists (GLP-1RA) are vital for managing atherosclerotic cardiovascular disease (ASCVD).
- Prior research on GLP-1RA cardiovascular benefits predominantly included obese patients.
- The efficacy of GLP-1RA in non-obese ASCVD patients remains under investigation.
Purpose of the Study:
- To investigate the cardiovascular effects of GLP-1RA in ASCVD patients across different body mass index (BMI) categories.
- To compare the impact of GLP-1RA on weight, metabolic indicators, and cardiac structure in normal weight, overweight, and obese ASCVD patients.
Main Methods:
- Retrospective cohort study of ASCVD patients.
- Patients were categorized into GLP-1RA and control groups, matched for age and BMI.
- Subgroup analysis based on baseline BMI: normal weight, overweight, and obesity.
Main Results:
- GLP-1RA treatment led to significant weight reduction in overweight and obese subgroups, but not in normal-weight individuals.
- GLP-1RA improved glucose metabolism across all BMI groups and blood lipids in overweight/obese patients.
- Cardiac structure improvements varied: atrial remodeling was more pronounced in normal-weight patients, while ventricular remodeling was more significant in obese patients.
Conclusions:
- GLP-1RA exerts differential effects on cardiac structure depending on baseline BMI.
- In obese patients, ventricular remodeling improvements may be linked to weight loss.
- In normal-weight patients, GLP-1RA might directly impact atrial remodeling via atrial GLP-1 receptors.
Background:
Glucagon-like peptide-1 receptor agonist(GLP-1RA) is commonly used in patients with cardiovascular disease due to its significant improvement in the prognosis of atherosclerotic cardiovascular disease (ASCVD). However, previous studies have primarily focused on obese patients, leaving uncertainty regarding whether GLP-1RA can yield similar cardiovascular benefits in individuals with normal or low body weight.
Methods:
In this study, we enrolled patients with ASCVD to establish a retrospective cohort. Patients receiving GLP-1RA treatment were assigned to the GLP-1RA group, while a control group was formed by matching age and body mass index (BMI) among patients not receiving GLP-1RA treatment. Each group was further divided into subgroups based on baseline BMI levels: normal weight, overweight, and obesity. A six-month follow-up was conducted to assess changes in patient weight, metabolic indicators, and cardiac structure and function.
Results:
Among the normal weight subgroup, no significant weight change was observed after six months of GLP-1RA treatment (57.4 ± 4.8 vs. 58.7 ± 9.2, p = 0.063). However, significant weight reduction was observed in the other two subgroups (Overweight group: 70.0 ± 9.1 vs. 73.1 ± 8.2, p = 0.003, Obesity group: 90.5 ± 14.3 vs. 95.5 ± 16.6, p<0.001). Regardless of baseline BMI levels, GLP-1RA demonstrated significant glucose-lowering effects in terms of metabolic indicators. However, GLP-1RA have a more significant effect on improving blood lipids in overweight and obese patients. The effects of GLP-1RA on cardiac structure exhibited variations among patients with different baseline BMI levels. Specifically, it was observed that the improvement in atrial structure was more prominent in patients with normal body weight(LAD: 33.0 (30.3, 35.5) vs. 35.0 (32.5, 37.1), p = 0.018, LAA (18.0 (16.0, 21.5) vs. 18.5 (16.5, 20.5), p = 0.008), while the enhancement in ventricular structure was more significant in obese subjects(LEVDD: 49.8 ± 5.8 vs. 50.2 ± 5.0, p < 0.001, LVMI: 65.1 (56.2, 71.4) vs. 65.8 (58.9, 80.4), p < 0.039).
Conclusion:
According to the study, it was found that the administration of GLP-1RA can have different effects on cardiac structure in patients with different baseline BMI, In obese patients, improvements in ventricular remodeling may be more associated with weight loss mechanisms, while in patients with normal or low BMI, GLP-1RA may directly improve atrial remodeling through GLP-1 receptors in atrial tissue.
