Key result
In obese patients with hypertrophic cardiomyopathy, GLP-1 RA use was associated with lower all-cause mortality compared with bariatric surgery (2.0% vs. 4.4%; HR 0.46; 95% CI 0.27-0.80; P=0.004).
Why the study?
The comparative outcomes of GLP-1 receptor agonists versus bariatric surgery in obese patients with hypertrophic cardiomyopathy remain unclear.
Does GLP-1 RA therapy improve clinical outcomes compared to bariatric surgery in obese patients with hypertrophic cardiomyopathy?
Cohort (n=5,002)
Yes
Does GLP-1 RA therapy improve clinical outcomes compared to bariatric surgery in obese patients with hypertrophic cardiomyopathy?
Hazard Ratio: 0.46 (95% CI 0.27–0.8)
Absolute Event Rate: 2% vs 4.4%
p-value: p=0.004
In obese patients with hypertrophic cardiomyopathy, GLP-1 receptor agonists were associated with lower all-cause mortality and heart failure hospitalizations compared to bariatric surgery over 24 months.
May warrant GLP-1 RA preference over bariatric surgery in obese HCM; hypothesis-generating and requires RCT confirmation before adoption.
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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Mahmoud et al. (2026) conducted a cohort in Hypertrophic cardiomyopathy and obesity (n=5,002). GLP-1 receptor agonists vs. Bariatric surgery was evaluated on All-cause mortality (HR 0.46, 95% CI 0.27-0.80, p=0.004). In obese patients with hypertrophic cardiomyopathy, GLP-1 RA use was associated with lower all-cause mortality compared with bariatric surgery (2.0% vs. 4.4%; HR 0.46; 95% CI 0.27-0.80; P=0.004).
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