GLP-1 Receptor Agonists Decrease the Rate of Rupture, Cardiac Events, and Death in Patients with Abdominal Aortic Aneurysms

Abdominal aortic aneurysm (AAA) is a degenerative condition involving several processes including inflammation, matrix remodeling, disruptions of vascular smooth muscle cells, and thrombus formation all 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. Data is limited on the impact of GLP-1RA on outcomes of patients with AAA. The aim of this study is to examine the association and possible impact of GLP-1RA on patients with AAA.

Data was sourced from the TriNetX research network, encompassing 123 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, diabetes, metformin use, hypertension, cardiac disease, tobacco use, chronic kidney 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.

We identified 412,490 patients with diagnosis of AAA who were undergoing 6-month surveillance between June 1, 2010 and April 16, 2024. After PSM, the GLP-1RA group (N=13,722) underwent fewer elective repairs at each timepoint (1.5% vs 2.3% at 2 years, 2.1% vs 3.0% at 5 years, P<.01) and had significantly fewer ruptures at two years (1.1% vs 1.8%, P<.01) and five years (1.6% vs 2.4%, P<.01) when compared to Group 2 (N=13,722). Group 1 also experienced significantly fewer MACE and all-cause mortality at two and five years. On multivariate analysis, GLP-1RA significantly reduced the risk of undergoing elective repair (HR 0.757, 95% CI [0.636-0.902], P<.01), rupture (HR 0.538, 95% CI [0.418-0.691], P<.01), all-cause mortality (HR 0.474, 95% CI [0.439-0.511], P<.001), and MACE (HR 0.825, 95% CI [0.794-0.857], P<.01) at 5 years.

The use of GLP-1RA in patients with AAA is associated with fewer ruptures, elective repairs, and improved rates of MACE and death. A prospective analysis may further elucidate if GLP-1RA should be prescribed to reduce the rate of aneurysm growth.