ISC 2025 | Glucagon-like peptide-1 receptor agonist use and outcomes in patients with cardiac amyloidosis

Good morning everybody. My name is Dr Vikash and I am from India and I would be very grateful for the opportunity given by the VJNeurology platform, where I can share the important findings that I have presented at AHA Stroke. Thanks to all the team involved in facilitating this. And I would like to thank all the co-authors involved in preparing this study. So this study is all about glucagon-like peptide-1 receptor agonist use and outcome in cardiac amyloidosis patients, a propensity score matched analysis, in which we use the TriNetX database. So no financial disclosure and no conflict of interest involved and any source of funding has been used in preparing this manuscript. So in this study, a total of after applying the inclusion and exclusion criteria, a total of 954 patients were observed with cardiac amyloidosis group in which GLP-1 RAs has been used and 37,000 patients in cardiac amyloidosis group without the GLP-1 intervention analyst were analyzed. After one-to-one propensity score matched analysis, The study cohort comprises 940 patients in both the group. The population at a mean age of 68.15 years and with 43% women and 24% black individuals. The baseline characteristics of pre and post PSM analysis were summarized in table 1. We will go through it later. And this PSM achieved an acceptable covariate balance between treatment group and a standard mean difference of less than 0.1. As we can see with both the tables that has been highlighted on the sheet right now, the first table is a follow-up of one year and the second table is a follow-up of three years, means short and long-term. We can classify it. And as we can see, the GLP-1 receptor agonist found to be associated with a significant reduction in the risk of all-cause mortality. A huge difference, a huge reduction has been observed with a risk ratio of 0.28 and a P value of less than 0.01. A similar trend has been observed for heart failure, acute myocardial infarction, ischemic stroke, atrial fibrillation, ventricular tachycardia, and MACE. When we go to the long-term follow-up of three years, we observed almost a similar trend, although the benefit of the mortality getting bit narrowed down. Now, before it was 0.28 and now it was 0.37. And heart failure risk reduction, almost similar trend has been observed here as well, with the reduction although getting narrowed down. Similar for acute myocardial infarction, ischemic stroke, ventricular fibrillation. However, it is very interesting to note that ventricular tachycardia was found to be non-significantly associated. Hence, the risk benefit is getting reduced, non-found to be comparable between both the groups. However, the MACE is still showing the significant benefit and getting reduced in GLP-1 treatment group compared to non-treatment group. And we are now going to the next slides with the Kaplan-Meier. This is showing a survival benefit. Mortality after one year follow-up, which we can see like the green line showing the patient without GLP-1 RA and the purple line showing the GLP-1 treatment group in amyloidosis patient having significant survival benefit. And the same trend has been observed at a three-year follow-up. So in this central illustration showing you glucagon-like peptide-1 receptor agonist in cardiac amyloidosis patients, a total of 37,954 patients involved. And after applying the propensity score matching with the baselines, all the covariates and risk factors and medications, we found out 940 patients in both the matched cohort. And part of the analysis we found out after one year and three years, all-cause mortality, MACE, heart failure, ischemic stroke, atrial fibrillation getting reduced, showing a potential association of GLP-1 RA in cardiac amyloidosis patients. However, ventricular tachycardia is found to be non-significantly reduced after three years of follow-up. Thank you.

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