GLP-1 receptor agonists for smoking cessation after acute coronary syndrome: from biological plausibility to clinical impact.

Introduction It has been suggested that GLP-1 receptor agonists (GLP-1 RAs) could offer additional benefits for smoking cessation due to their modulation of reward pathways and anti-craving effects, in addition to their established cardiovascular benefits. Purpose Our aim was to evaluate the impact of GLP-1 RAs on smoking cessation following admission for acute coronary syndrome (ACS). Methods A prospective observational study was conducted in a cohort of active smokers hospitalized for ACS at our center, with angiographically proven coronary artery disease. After one year of follow-up, self-reported smoking abstinence and its associated factors were analyzed, with a focus on GLP-1 RAs prescription at discharge. Appropriate comparison tests and binary logistic regression analysis were used for this purpose. Results A total of 200 patients were included (mean age: 58.2 ± 10.0 years; 16.5% women). At 1-year follow-up, only 61% had successfully quit smoking. No significant differences in smoking cessation were observed according to age, sex, cardiovascular risk factors, ACS presentation, Killip class, or previous cardiovascular disease (Table). Notably, cumulative tobacco exposure (pack-years) was not significantly associated with cessation success. Regarding conventional smoking cessation pharmacotherapies, detailed in Figure (nicotine replacement therapy, bupropion, or varenicline—the latter unavailable for most of the study period), these were infrequently prescribed (23%) and were not significantly associated with smoking cessation. Prescription of GLP-1 RAs at discharge (14.5% of patients, all with diabetes; 96.6% receiving semaglutide) was associated with a remarkably high abstinence rate (89.7% vs. 56.1% in the non-GLP-1 RA group; p=0.001). Specifically, within the diabetic subgroup, patients on GLP-1 RAs achieved significantly higher cessation rates compared to those on other glucose-lowering therapies (86.4% vs. 56.9%; p=0.014). In the multivariable model, GLP-1 RAs emerged as an independent predictor of smoking cessation (OR 5.844; 95% CI 1.620-21.079; p=0.007), alongside participation in cardiac rehabilitation (OR 2.108; 95% CI 1.072-4.144; p=0.031). Conclusions In our cohort, nearly 40% of patients continued smoking one year after an acute coronary syndrome. In addition to the well-established benefits of cardiac rehabilitation, prescription of GLP-1 RAs at discharge was independently associated with smoking cessation. These findings support the need for randomized clinical trials to confirm this potential benefit of GLP-1 RAs, which could have relevant implications for post-ACS management.TableFigure