Glucagon-like peptide-1 receptor agonists and the risk of atrial fibrillation in adults with diabetes: a real-world study.
Glucagon-like peptide-1 receptor agonists and the risk of atrial fibrillation in adults with diabetes: a real-world study.
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胰高血糖素样肽 1 受体激动剂与成人糖尿病患者心房颤动的风险：一项真实世界研究。
DOI：
10.1007/s11606-023-08589-3
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发表时间：
2024
影响因子：
5.7
通讯作者：
Shin,Jung-Im
中科院分区：
文献类型：
--
作者：
Xu,Yunwen;Boyle,ThomasA;Lyu,Beini;Ballew,ShoshanaH;Selvin,Elizabeth;Chang,AlexanderR;Inker,LesleyA;Grams,MorganE;Shin,Jung-Im
背景胰高血糖素样肽-1受体激动剂（GLP-1 RA）对2型糖尿病有心血管方面的益处，但目前尚无心血管试验将房颤/房扑（AF）作为主要终点。来自上市后监测研究的数据仍然很少。目的比较GLP-1 RA与其他非胰岛素降糖药，检查AF的真实风险。设计队列研究，使用Optum Labs数据仓库中去识别的电子健康记录数据。2005年至2010年期间，新处方添加非胰岛素降糖药并使用二甲双胍的成年糖尿病患者。2020.暴露GLP-1 RA的新使用者分别与二肽基肽酶-4抑制剂（DPP 4 i）和钠-葡萄糖协同转运蛋白2抑制剂（SGLT 2 i）的新使用者进行比较，使用1：1倾向评分匹配，以调整患者特征的差异。主要测量主要结局是AF事件，由AF诊断代码定义和捕获。在匹配队列中估计发病率差异（IRD）和风险比（HR）。对566对GLP-1 RA和DPP 4 i进行中位随访3.8年，GLP-1 RA使用与AF风险降低相关（IRD，-1.0; 95% CI，-1.8至-0.2/1000人-年; HR，0.82; 95% CI，0.70至0.96）。在9，424对接受GLP-1 RA和SGLT 2 i治疗的患者的匹配队列中，中位随访时间为2.9年，AF风险无差异（IRD，0.4; 95% CI -0.7至1.5/1000人-年; HR，1.12; 95%CI，0.89至1.42）。结论在这项真实世界研究中，GLP-1 RA与较低的AF风险相关，与DPP 4 i相比，但与SGLT 2 i相比无差异，这表明GLP-1 RA的心血管获益可能扩展到糖尿病患者的AF预防。我们的研究结果呼吁未来的随机对照试验关注GLP-1 RA对AF预防的影响。
BackgroundGlucagon-like peptide-1 receptor agonists (GLP-1RA) have cardiovascular benefits in type 2 diabetes, but none of the cardiovascular trials studied atrial fibrillation/atrial flutter (AF) as a primary endpoint. Data from post-marketing surveillance studies remains sparse.ObjectiveTo examine the real-world risk of AF comparing GLP-1RA with other non-insulin glucose-lowering agents.DesignCohort study using de-identified electronic health record data from the Optum Labs Data Warehouse.ParticipantsAdult patients with diabetes who were newly prescribed add-on non-insulin glucose-lowering agents and were on metformin between 2005-2020.ExposuresNew users of GLP-1RA were separately compared with new users of dipeptidyl peptidase-4 inhibitors (DPP4i) and sodium-glucose cotransporter 2 inhibitors (SGLT2i), using 1:1 propensity score matching to adjust for differences in patient characteristics.Main MeasuresThe primary outcome was incident AF, defined and captured by diagnosis code for AF. Incidence rate difference (IRD) and hazard ratio (HR) were estimated in the matched cohorts.Key ResultsIn the matched cohort of 14,566 pairs of GLP-1RA and DPP4i followed for a median of 3.8 years, GLP-1RA use was associated with a lower risk of AF (IRD, -1.0; 95% CI, -1.8 to -0.2 per 1000 person-years; HR, 0.82; 95% CI, 0.70 to 0.96). In the matched cohort of 9,424 pairs of patients on GLP-1RA and SGLT2i with a median follow-up of 2.9 years, there was no difference in the risk for AF (IRD, 0.4; 95% CI -0.7 to 1.5 per 1000 person-years; HR, 1.12; 95% CI, 0.89 to 1.42).ConclusionsIn this real-word study, GLP-1RA was associated with a lower risk of AF compared with DPP4i, but no difference compared with SGLT2i, suggesting that cardiovascular benefits of GLP-1RA use may extend to prevention for AF in patients with diabetes. Our findings call for future randomized controlled trials to focus on the effects of GLP-1RA on AF prevention.