GLP-1 receptor agonists and clinical outcomes in patients with type 2 diabetes undergoing transcatheter aortic valve implantation

AIMS: We evaluated clinical outcomes with GLP-1 RA use post-TAVI in patients with T2D. GLP-1 receptor agonists (GLP1-RAs) lower cardiovascular risk in type 2 diabetes (T2D), but their impact in patients with valvular heart disease, including those undergoing transcatheter aortic-valve implantation (TAVI), remained unexplored. METHODS AND RESULTS: We conducted a retrospective cohort study using the TriNetX network, including 25 184 adults (≥18 years) with T2D who underwent TAVI (2015-2023). Patients were stratified based on GLP1-RA initiation within 14 days post-TAVI. Baseline characteristics, comorbidities, medications, and laboratory data were balanced using 1:1 propensity score matching (PSM). Cox models estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for events from one-month post-TAVI until the most recent follow-up. PSM yielded 1101 patients per group, with a mean age of 73 years and 39% female. Mean follow-up duration was 2.2 ± 1.1 and 2.6 ± 1.8 years for GLP1-RA users and non-users, respectively. GLP1-RA use was also associated higher survival probability (HR: 0.708 95% CI: 0.583-0.859), and lower rates of all-cause hospitalization (HR: 0.790 95% CI, 0.706-0.885), major cardiovascular events (HR: 0.849 95% CI: 0.749-0.963), and acute heart failure exacerbation (HR: 0.785 95% CI: 0.677-0.909), acute kidney injury (HR: 0.843 95% CI: 0.719-0.988), and major kidney events (HR: 0.665 95% CI: 0.510-0.866). No differences were observed in acute myocardial infarction, cerebral infarction, or cardiac arrest. CONCLUSION: In patients with T2D undergoing TAVI, GLP1-RA use is associated with significant survival benefits and improved cardiorenal outcomes. However, these findings are limited by the observational design, high comorbidity burden, lack of data on medication compliance, and specific cause of death. Prospective trials are warranted to confirm these benefits.