Abstract/Description
Introduction: Obstructive sleep apnea (OSA) is a well-established risk factor for cardiovascular disease. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have demonstrated promising potential in reducing cardiovascular risk and alleviating the severity of OSA. However, a significant knowledge gap remains regarding the impact of GLP-1RAs on cardiovascular events in OSA patients. This study utilizes large-scale global electronic healthcare record data to evaluate the associations of GLP-1RAs with improved cardiovascular outcomes.
Methods: We conducted a propensity score-matched retrospective cohort study using aggregate data from the TriNetX Global Network, which includes over 160 million patients from more than 120 healthcare organizations worldwide. The study population comprised patients with a BMI over 30 who were diagnosed with OSA between January 2010 and November 2021. Patients with a diagnosis of heart failure, pulmonary hypertension, or myocardial infarction were excluded. Two cohorts were created: one consisting of patients prescribed GLP-1RAs (semaglutide, liraglutide, or dulaglutide) within one year before their OSA diagnosis, and the other comprising OSA patients who were never prescribed any GLP-1RAs. Propensity score matching was performed using TriNetX software, which relies on the greedy nearest neighbor methodology. Cox proportional hazards analyses were conducted over a three-year follow-up period. The primary outcome was heart failure. Secondary outcomes included pulmonary hypertension and acute myocardial infarction (AMI).
Results: We included 16,992 patients in the GLP-1RA cohort and 727,130 patients in the non-GLP-1RA cohort. Propensity score matching resulted in 16,881 patients remaining in each cohort, which were well-matched in demographics (age 54.8 vs. 55.7, White: 62.3% vs. 61.9%, Female: 51.3% vs. 53.1%), comorbidities, medications, BMI (40.7 vs. 40.8), and HbA1c (7.6 vs. 7.5). In the GLP-1RA cohort, most patients received liraglutide (50.2%), followed by dulaglutide (36.1%), and semaglutide (20.1%). After 3 years of follow-up, the GLP-1RA cohort had a significantly lower risk of newly developed heart failure (1,206 vs. 1,579 cases; HR: 0.73, 95% CI: 0.67-0.78), pulmonary hypertension (329 vs. 499 cases; HR: 0.63, 95% CI: 0.55-0.73), and AMI (324 vs. 482 cases; HR: 0.65, 95% CI: 0.56- 0.74).
Conclusion: GLP-1RA use was associated with reduced risks of heart failure, pulmonary hypertension, and AMI in obese OSA patients. Prospective studies are needed for validation.
Faculty Advisor/Mentor
Joshua Sill
Faculty Advisor/Mentor Department
Pulmonary and Critical Care
College/School/Affiliation
Eastern Virginia Medical School (EVMS)
Included in
Association of Glucagon-like Peptide-1 Receptor Agonist Use with Cardiovascular Risk Reduction in Patients with Obstructive Sleep Apnea and Obesity: A Real-world Analysis
Introduction: Obstructive sleep apnea (OSA) is a well-established risk factor for cardiovascular disease. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have demonstrated promising potential in reducing cardiovascular risk and alleviating the severity of OSA. However, a significant knowledge gap remains regarding the impact of GLP-1RAs on cardiovascular events in OSA patients. This study utilizes large-scale global electronic healthcare record data to evaluate the associations of GLP-1RAs with improved cardiovascular outcomes.
Methods: We conducted a propensity score-matched retrospective cohort study using aggregate data from the TriNetX Global Network, which includes over 160 million patients from more than 120 healthcare organizations worldwide. The study population comprised patients with a BMI over 30 who were diagnosed with OSA between January 2010 and November 2021. Patients with a diagnosis of heart failure, pulmonary hypertension, or myocardial infarction were excluded. Two cohorts were created: one consisting of patients prescribed GLP-1RAs (semaglutide, liraglutide, or dulaglutide) within one year before their OSA diagnosis, and the other comprising OSA patients who were never prescribed any GLP-1RAs. Propensity score matching was performed using TriNetX software, which relies on the greedy nearest neighbor methodology. Cox proportional hazards analyses were conducted over a three-year follow-up period. The primary outcome was heart failure. Secondary outcomes included pulmonary hypertension and acute myocardial infarction (AMI).
Results: We included 16,992 patients in the GLP-1RA cohort and 727,130 patients in the non-GLP-1RA cohort. Propensity score matching resulted in 16,881 patients remaining in each cohort, which were well-matched in demographics (age 54.8 vs. 55.7, White: 62.3% vs. 61.9%, Female: 51.3% vs. 53.1%), comorbidities, medications, BMI (40.7 vs. 40.8), and HbA1c (7.6 vs. 7.5). In the GLP-1RA cohort, most patients received liraglutide (50.2%), followed by dulaglutide (36.1%), and semaglutide (20.1%). After 3 years of follow-up, the GLP-1RA cohort had a significantly lower risk of newly developed heart failure (1,206 vs. 1,579 cases; HR: 0.73, 95% CI: 0.67-0.78), pulmonary hypertension (329 vs. 499 cases; HR: 0.63, 95% CI: 0.55-0.73), and AMI (324 vs. 482 cases; HR: 0.65, 95% CI: 0.56- 0.74).
Conclusion: GLP-1RA use was associated with reduced risks of heart failure, pulmonary hypertension, and AMI in obese OSA patients. Prospective studies are needed for validation.