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Association of GLP-1 receptor agonists versus bariatric surgery with outcomes in obese patients with hypertrophic
Ahmed K Mahmoud1,2, Kamal Awad1, Hesham Sheashaa1
1Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ 85054, USA.
Insights
In obese patients with hypertrophic cardiomyopathy (HCM), glucagon-like peptide-1 receptor agonists (GLP-1 RA) were linked to lower mortality and heart failure hospitalizations compared to bariatric surgery.
Area of Science:
- Cardiology
- Metabolic Disorders
- Pharmacology
Background:
- Obesity is a significant risk factor for adverse outcomes in patients with hypertrophic cardiomyopathy (HCM).
- Both bariatric surgery (BS) and glucagon-like peptide-1 receptor agonists (GLP-1 RA) facilitate weight loss and may improve cardiometabolic health.
- Comparative effectiveness of BS versus GLP-1 RA in HCM patients is not well-established.
Purpose of the Study:
- To compare the 24-month clinical outcomes of GLP-1 RA therapy versus bariatric surgery in obese patients with HCM.
- To evaluate the impact of these weight-loss interventions on mortality, heart failure hospitalizations, arrhythmias, and cardiovascular symptoms.
Main Methods:
- A retrospective cohort study included 1,910 obese adults (BMI ≥ 30 kg/m²) with HCM, divided into GLP-1 RA users (never had BS) and BS patients (never used GLP-1 RA).
- Propensity score matching (1:1) was employed to balance baseline characteristics, comorbidities, and medications between the two groups.
- Cox proportional hazards models were used to estimate hazard ratios for outcomes including all-cause mortality, acute heart failure hospitalization, and arrhythmias.
Main Results:
- After matching, GLP-1 RA use was associated with significantly lower rates of all-cause mortality (2.0% vs 4.4%; HR 0.46) and heart failure hospitalization (8.7% vs 14.0%; HR 0.60) compared to BS.
- Composite cardiovascular outcomes were also lower with GLP-1 RA (10.7% vs 17.2%; HR 0.60).
- While bariatric surgery led to greater BMI reduction (-4.0 vs -2.6 kg/m²), rates of arrhythmias and cardiovascular symptoms were comparable between groups.
Conclusions:
- In obese patients with HCM, GLP-1 RA therapy demonstrated superior outcomes regarding all-cause mortality and heart failure hospitalizations compared to bariatric surgery.
- These findings suggest GLP-1 RA as a potentially beneficial treatment strategy for weight management in HCM.
- Further prospective studies are needed to validate these comparative effectiveness findings.
Aims:
Obesity is linked with worse outcomes in hypertrophic cardiomyopathy (HCM). While both bariatric surgery (BS) and GLP-1 receptor agonists (GLP-1RA) promote weight loss and may improve cardiometabolic risk, their comparative outcomes in HCM remain unclear.
Methods And Results:
Adults with HCM and body mass index (BMI) ≥ 30 kg/m were divided into two cohorts: (i) GLP-1 RA users who never had BS, and (ii) BS patients who never received GLP-1 RA. Propensity score matching (1:1) was performed to balance demographics, comorbidities, and medications. Outcomes over 24 months include all-cause mortality, acute heart failure (HF) hospitalization, arrhythmias, change in BMI, and cardiovascular symptoms. Hazard ratios with 95% confidence intervals were estimated using Cox models. Of 5002 patients, 955 were included in each matched cohort after matching (mean age 54 ± 13 years, 70% female, BMI 40.0 kg/m). GLP-1 RA was associated with a significantly lower observed rate of all-cause mortality compared with BS (2.0% vs. 4.4%; HR 0.46; 95% CI 0.27-0.80; P = 0.004) and HF hospitalization (8.7% vs. 14.0%; HR 0.60; 95% CI 0.46-0.79; P < 0.001). Similarly, GLP-1 RA use was associated with a lower incidence of composite cardiovascular outcomes (10.7% vs. 17.2%; HR 0.60; 95% CI 0.47-0.77; P < 0.001). Rates of arrhythmia and cardiovascular symptoms were comparable between the two groups. BMI reduction was greater after bariatric surgery (-4.0 vs. -2.6 kg/m; P < 0.001).
Conclusion:
In obese patients with HCM, GLP-1 RA therapy was associated with lower all-cause mortality and fewer HF events compared with BS. Future studies are warranted to confirm our findings.
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