Mahmoud Ahmed K, Kamel Ibrahim, Awad Kamal, Farina Juan, Ibrahim Ramzi, Abdelnabi Mahmoud, Allam Mohamed, Pham Hoang Nhat, Rosenthal Julie, Steidley Eric, Lester Steven J, Horn Benjamin, Ayoub Chadi, Arsanjani Reza
Cardiovascular Medicine Department, Mayo Clinic, Phoenix, AZ, USA; Internal Medicine Department, Boston Medical Center - Brighton, Boston University School of Medicine, Boston, MA, USA.
Internal Medicine Department, Boston Medical Center - Brighton, Boston University School of Medicine, Boston, MA, USA.
Int J Cardiol. 2025 Nov 1;438:133567. doi: 10.1016/j.ijcard.2025.133567. Epub 2025 Jun 29.
Transthyretin cardiac amyloidosis (ATTR-CA) is a progressive infiltrative cardiomyopathy that can lead to symptomatic heart failure (HF). Sodium-glucose co-transporter 2 inhibitors (SGLT2i) have shown favorable cardiovascular and metabolic effects, with significant benefits in ATTR-CA. With the widespread use of GLP-1 receptor agonists (GLP-1RAs), their potential in this population is of interest. This study sought to investigate the added effects of GLP-1RA to SGLT2i in ATTR-CA patients.
We identified patients with ATTR-CA and SGLT2i use from 2013 to 2024. Two cohorts were compared: patients on both GLP-1RA and SGLT2i and those on SGLT2i alone. Primary outcomes included all-cause mortality and major adverse cardiovascular events (MACE). Secondary outcomes were HF exacerbations, ischemic stroke, all-cause hospitalization, atrial fibrillation, and ventricular arrythmia.
After propensity score matching, the GLP-1RA cohort had a significant reduction in all-cause mortality (1.8 % vs 5.5 %; HR 0.30, 95 %CI 0.16-0.55, p < 0.0001) and MACE (14.0 % vs 19.3 %; HR 0.64, 95 %CI 0.50-0.83, p = 0.0006) at 12-month follow-up. Additionally, GLP-1RA use was associated with lower risks of ischemic stroke, HF exacerbations, and all-cause hospitalization, with no significant difference in new-onset atrial fibrillation or ventricular arrhythmias.
The combined use of GLP-1RA and SGLT2i in ATTR-CA appears to confer incremental prognostic value.
转甲状腺素蛋白心脏淀粉样变（ATTR-CA）是一种进行性浸润性心肌病，可导致症状性心力衰竭（HF）。钠-葡萄糖协同转运蛋白2抑制剂（SGLT2i）已显示出良好的心血管和代谢效应，对ATTR-CA有显著益处。随着胰高血糖素样肽-1受体激动剂（GLP-1RAs）的广泛应用，其在该人群中的潜力备受关注。本研究旨在探讨GLP-1RA对ATTR-CA患者使用SGLT2i的附加作用。
我们确定了2013年至2024年使用SGLT2i的ATTR-CA患者。比较了两个队列：同时使用GLP-1RA和SGLT2i的患者以及仅使用SGLT2i的患者。主要结局包括全因死亡率和主要不良心血管事件（MACE）。次要结局为心力衰竭加重、缺血性卒中、全因住院、心房颤动和室性心律失常。
倾向评分匹配后，GLP-1RA队列在12个月随访时全因死亡率显著降低（1.8%对5.5%；HR 0.30，95%CI 0.16 - 0.55，p < 0.0001），MACE也显著降低（14.0%对19.3%；HR 0.64，95%CI 0.50 - 0.83，p = 0.0006）。此外，使用GLP-1RA与缺血性卒中、心力衰竭加重和全因住院风险降低相关，新发心房颤动或室性心律失常无显著差异。
在ATTR-CA中联合使用GLP-1RA和SGLT2i似乎具有额外的预后价值。
