Abstract Body:

Background
Despite their potential, Glucagon-like peptide-1 receptor agonists (GLP-1 RA) have not been well studied in cardiac amyloidosis (CA) as randomized trials on GLP-1 RA have excluded patients with this morbid disease.
Objective
This study aims to investigate the association of GLP-1 RA with outcomes in patients with Cardiac Amyloidosis.
Method
The TriNeTX Global Collaborative Network research database was used to identify patients aged ≥18 years of age from January 2005 to August 2023. Patients were categorized into two groups, one with cardiac amyloidosis on GLP-1 RA and a control group with cardiac amyloidosis without GLP-1 RA. Patients were assessed at follow-up periods of 1 month and 1 year. Propensity score-matched analysis (PSM) (1:1) was performed with matching for age, gender, race, BMI, hypertension, diabetes mellitus, chronic kidney disease, hemoglobin level, low-density lipid (LDL) level, left ventricular ejection fraction, and various drugs including ACEi, ARBi, ARNI, beta-blockers, and diuretics. Primary outcome was risk of ischemic stroke while secondary outcomes were all-cause mortality (ACM), heart failure, acute myocardial infarction (AMI), major adverse cardiovascular events (MACE), atrial fibrillation (AF), and ventricular tachycardia (VT).
Result
After 1:1 propensity score matching, the study cohort comprised 895 patients receiving GLP-1 RA and 895 patients in the control group. The study population had a mean age of 68± 0.14 years, with 49.27% men. PSM analysis showed that GLP-1 RA did not reduce the risk of ischemic stroke after 1 month (RR, 1.00(95%CI: 0.42-2.39), P=0.99). However, GLP-1 RA significantly reduced the risk of ischemic stroke after 1 year (RR, 0.43(95%CI: 0.25-0.73), P<0.01). A significant reduction in the risk of ACM after 1 month (RR, 0.28(95%CI: 0.14-0.56), P<0.01), and after 1 year (RR, 0.32(95%CI: 0.23-0.45), P<0.01) was observed. Similarly, a significant reduction in the risk of MACE after 1 year (RR, 0.28(95:CI: 0.17-0.46), P<0.01), AMI after 1 year (RR, 0.55(95%CI: 0.35-0.88), P=0.01), and AF after 1 year (RR, 0.58(95%CI: 0.36-0.94), P=0.01) was observed among GLP-1 RA group patients. Risk of Heart failure and VT was comparable.
Conclusion
These findings indicated that GLP-1 RA are associated with a reduction in the risk of ischemic stroke, all cause mortality, MACE, and atrial fibrillation among cardiac amyloidosis patients, without increasing the risk of heart failure, or ventricular tachycardia.