GLP-1 agonists linked to real-world cardiovascular benefits in patients with co-existing diabetes and COPD
Presenter:
Xin Ya See, MD, Department of Medicine, Unity Hospital/Rochester Regional Health, Rochester, NY
GLP-1 agonists reduced cardiovascular risk and mortality in patients with type 2 diabetes mellitus and COPD in a retrospective study, suggesting use of these drugs could be a “game-changer” in this high-risk patient population.
The use of glucagon-like peptide 1 (GLP-1) agonists may reduce cardiovascular and mortality risks in patients with co-existing chronic obstructive pulmonary disease (COPD) and type 2 diabetes mellitus (T2DM), according to authors of a recent retrospective study.
In patients with both COPD and T2DM, use of a GLP-1 agonist was associated with a 15% reduction in risk of major adverse cardiovascular events (MACE) and a 41% drop in mortality risk, according to the researchers, who presented their findings at the CHEST 2024 meeting.
Although further study is needed, the present results suggest that GLP-1 drugs may become “a preferred treatment option” for managing both metabolic and cardiovascular risks in COPD, according to Xin Ya See, MD, lead author of the study.
“GLP-1 agonists, already known for their cardiovascular benefits in type 2 diabetes and obesity, could be a game-changer for patients with co-existing COPD and type 2 diabetes,” Dr. See said in an interview.
The findings warrant further investigation, and could potentially alter clinical practice in the near future for patients with COPD, Dr. See added.
Cardiovascular risks are often high in patients with COPD due to chronic inflammation, tobacco use, comorbidities, and treatment-related toxicity. This risk is increased even further in patients with T2DM, noted Dr. See and study co-authors in a poster presentation of their results.
Recent studies have shown that T2DM patients receive cardiovascular benefits from treatment with GLP-1 agonists such as semaglutide or the glucose-dependent insulinotropic polypeptide (GIP)/GLP-1 co-agonist tirzepatide, the authors continued.
By contrast, the cardiovascular effects of these agents in patients with COPD remains largely unexplored.
Accordingly, Dr. See and co-authors sought to evaluate the effects of GLP-1 agonists on cardiovascular outcomes in nearly 326,000 patients in the TriNetX Analytics Network international database who were diagnosed with both COPD and T2DM between April 2005 and March 2022.
The analysis focused on a subset of 19,982 patients with COPD and T2DM who received at least 1 prescription for a GLP-1 agonist or a GIP/GLP-1 co-agonist 1 year before or after their COPD diagnosis. They were compared to a matched cohort of 19,982 patients with COPD and T2DM for whom GLP-1 drugs had not been prescribed.
As noted, the GLP-1 drug cohort had a 15% lower risk of MACE (hazard ratio [HR] 0.85, 95% confidence interval [CI] 0.80–0.92). This included 15% lower risk of heart failure and heart failure exacerbations, 12% reduced risk of myocardial infarction, and 37% reduced risk of cardiac arrest, according to the authors.
There were no differences between the GLP-1 and non-GLP-1 cohorts in risks of atrial fibrillation or flutter, cerebrovascular disease, transient ischemic attacks, or peripheral vascular disease, they added.
The GLP-1 group also had a 41% reduced risk of all-cause mortality (HR 0.59, 95% CI 0.55–0.63) but also a higher risk of gastroparesis (HR 1.35, 95% CI 1.14–1.61), they concluded.
Altogether, these data suggest a “potentially pivotal role” for GLP-1 agonists in improving outcomes for this high-risk population, Dr. See said in the interview.
“Currently, GLP-1 agonists are approved for managing type 2 diabetes and obesity,” Dr. See explained. “However, given the elevated cardiovascular and mortality risks in COPD patients, these agents could be considered as first-line glucose-lowering therapy for patients with both COPD and type 2 diabetes.”
“Their potential to reduce cardiovascular events and mortality could redefine treatment approaches in this comorbid population,” Dr. See added.
Disclosures:
Dr. See and co-authors reported no relevant relationships.
Suggested Reading:
Rogliani P, Ritondo BL, Laitano R, Chetta A, Calzetta L. Advances in understanding of mechanisms related to increased cardiovascular risk in COPD. Expert Rev Respir Med 2021; 15(1):59–70. doi: 10.1080/17476348.2021.1840982.
Vivodtzev I, Maltais F. Cardiovascular risk in COPD: Searching for a culprit. Chest 2020; 157(4):753–754. doi: 10.1016/j.chest.2020.01.008.
Kristensen SL, Rørth R, Jhund PS, et al. Cardiovascular, mortality, and kidney outcomes with GLP-1 receptor agonists in patients with type 2 diabetes: a systematic review and meta-analysis of cardiovascular outcome trials. Lancet Diabetes Endocrinol 2019; 7(10):776–785. doi: 10.1016/S2213-8587(19)30249-9.
Lincoff AM, Brown-Frandsen K, Colhoun HM, et al. Semaglutide and cardiovascular outcomes in obesity without diabetes. N Engl J Med 2023; 389(24):2221–2232. doi: 10.1056/NEJMoa2307563.
Min T, Bain SC. The role of tirzepatide, dual GIP and GLP-1 receptor agonist, in the management of type 2 diabetes: The SURPASS clinical trials. Diabetes Ther 2021; 12(1):143–157. doi: 10.1007/s13300-020-00981-0.