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GLP-1 receptor agonist use and long-term outcomes in hypertrophic cardiomyopathy with obstructive sleep apnoea: A real-world cohort analysis
Open accessAbstract
Obstructive sleep apnoea (OSA) is prevalent in hypertrophic cardiomyopathy (HCM) and may contribute to adverse cardiometabolic and cardiovascular outcomes. Although glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are effective for cardiometabolic risk management, their association with long-term outcomes in adults with HCM and OSA remains unclear. To evaluate the association between GLP-1 RA exposure and long-term clinical outcomes in adults with HCM and OSA. We performed an observational cohort study using the TriNetX Global Collaborative Network. Adults (≥18 years) with HCM (ICD-10 I42.1/I42.2) and OSA (ICD-10 G47.33) were identified. Exposure was GLP-1 RA use after HCM diagnosis; the comparator cohort had no GLP-1 RA use. Patients with prior heart transplant, septal reduction therapy, or myectomy were excluded. Propensity score matching (1:1) was performed across 18 covariates (including age, sex, body mass index, and comorbidities). Outcomes were assessed from day 1 after cohort entry and continued up to 5,475 days (~15 years). The primary outcome was major adverse cardiovascular events (MACE: all-cause mortality, acute myocardial infarction, ischaemic stroke). Secondary outcomes were acute heart failure hospitalisation and arrhythmias (atrial fibrillation/flutter, ventricular fibrillation, ventricular tachycardia). Baseline characteristics after matching are shown in Figure 1a. Before matching, cohort sizes were 4,962 (GLP-1 RA) and 36,249 (no GLP-1 RA); after matching, 4,930 patients were included in each cohort. For MACE (excluding patients with a prior outcome for risk estimates), cumulative risk was 10.0% vs 15.4% (odds ratio 0.61; absolute risk difference −5.4%; p<0.0001). In time-to-event analysis (Figure 1b), the MACE hazard ratio (HR) was 0.64 (95% CI 0.59–0.71; log-rank p<0.0001), with MACE-free survival at 5,475 days of 54.3% vs 31.7%. For acute heart failure hospitalisation (excluding prior such events), cumulative risk was 4.7% vs 5.1% (odds ratio or OR 0.92; p=0.40); Cox proportional HR was 0.84 (95% CI 0.70–1.02; log-rank p=0.08). For arrhythmias (excluding prior events), cumulative risk was 12.8% vs 11.2% (OR 1.16; p=0.04); Cox proportional HR was 1.07 (95% CI 0.93–1.23; log-rank p=0.38). In this large real-world cohort of adults with HCM and OSA, GLP-1 RA exposure was associated with lower odds of MACE and improved long-term MACE-free survival. No statistically significant difference was observed for acute heart failure hospitalisations. Prospective studies are warranted to confirm these associations.Figure for HCM OSA
Overview
AI snapshot
Written from the paper’s full text.
TL;DR
In a large real-world cohort of adults with hypertrophic cardiomyopathy (HCM) and obstructive sleep apnoea (OSA), GLP-1 receptor agonist (GLP-1 RA) exposure was associated with lower odds of major adverse cardiovascular events (MACE) and better long-term MACE-free survival. No statistically significant difference was seen for acute heart failure hospitalisation, and the authors call for prospective studies to confirm the associations.
Key findings
- MACE (all-cause mortality, acute myocardial infarction, ischaemic stroke; excluding patients with a prior outcome): cumulative risk 10.0% with GLP-1 RA vs 15.4% without (odds ratio 0.61; absolute risk difference −5.4%; p < 0.0001). Time-to-event analysis gave a MACE hazard ratio of 0.64 (95% CI 0.59–0.71; log-rank p < 0.0001), with MACE-free survival at 5,475 days of 54.3% vs 31.7%.
- Acute heart failure hospitalisation (excluding prior such events): cumulative risk 4.7% vs 5.1% (OR 0.92; p = 0.40); Cox proportional HR 0.84 (95% CI 0.70–1.02; log-rank p = 0.08).
- Arrhythmias (atrial fibrillation/flutter, ventricular fibrillation, ventricular tachycardia; excluding prior events): cumulative risk 12.8% vs 11.2% (OR 1.16; p = 0.04); Cox proportional HR 1.07 (95% CI 0.93–1.23; log-rank p = 0.38).
- Before matching, cohort sizes were 4,962 (GLP-1 RA) and 36,249 (no GLP-1 RA); after 1:1 matching, 4,930 patients per cohort.
Methods
- Observational cohort study using the TriNetX Global Collaborative Network. Adults (≥ 18 years) with HCM (ICD-10 I42.1/I42.2) and OSA (ICD-10 G47.33) were identified; exposure was GLP-1 RA use after HCM diagnosis, with a no-GLP-1-RA comparator cohort.
- Patients with prior heart transplant, septal reduction therapy, or myectomy were excluded. Propensity score matching (1:1) was performed across 18 covariates, including age, sex, body mass index, and comorbidities.
- Outcomes were assessed from day 1 after cohort entry and followed up to 5,475 days (~15 years). Primary outcome was MACE; secondary outcomes were acute heart failure hospitalisation and arrhythmias. Analyses included cumulative risk/odds ratios and time-to-event (Cox proportional hazards, Kaplan-Meier, log-rank) comparisons.
Limitations
- The paper states that prospective studies are warranted to confirm these associations; no other limitations are explicitly listed in the abstract.
- Evident from the text: this is a retrospective, claims/database-based observational cohort, so residual confounding and coding misclassification cannot be excluded despite propensity score matching; the abstract reports no information on specific GLP-1 RA agents, doses, or adherence.
- Evident from the text: the arrhythmia result is discordant across analyses (OR 1.16, p = 0.04 vs HR 1.07, log-rank p = 0.38), and the acute heart failure hospitalisation comparison did not reach statistical significance.
Model-written summary. Check it against the paper before relying on it.
Integrity signals
Registry
Cites
Statistics
Verification
Claims the paper makes
6 Own result · 2 Own method
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“For MACE (excluding patients with a prior outcome for risk estimates), cumulative risk was 10.0% vs 15.4% (odds ratio 0.61; absolute risk difference -5.4%; p < 0.0001).”
- Also stated in: § GLP-1 receptor agonist use and long-term outcomes in hypertrophic cardiomyopathy with obstructive sleep apnoea: A real-world cohort analysis · p. 1 · plain
“In this large real-world cohort of adults with HCM and OSA, GLP-1 RA exposure was associated with lower odds of MACE and improved long-term MACE-free survival.”
plaincorrelationaln = 4,930 ·- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Also stated in: § GLP-1 receptor agonist use and long-term outcomes in hypertrophic cardiomyopathy with obstructive sleep apnoea: A real-world cohort analysis · p. 1 · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“For arrhythmias (excluding prior events), cumulative risk was 12.8% vs 11.2% (OR 1.16; p = 0.04); Cox proportional HR was 1.07 (95% CI 0.93 -1.23; log-rank p = 0.38).”
plainn = 4,930- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“In time-to-event analysis (Figure 1b), the MACEhazard ratio (HR) was 0.64 (95% CI 0.59 -0.71; log-rank p < 0.0001), with MACE-free survival at 5,475 days of 54.3% vs 31.7%.”
plaincorrelationaln = 4,930 ·- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“In time-to-event analysis (Figure 1b), the MACEhazard ratio (HR) was 0.64 (95% CI 0.59 -0.71; log-rank p < 0.0001), with MACE-free survival at 5,475 days of 54.3% vs 31.7%.”
- Also stated in: § GLP-1 receptor agonist use and long-term outcomes in hypertrophic cardiomyopathy with obstructive sleep apnoea: A real-world cohort analysis · p. 1 · plain
“In this large real-world cohort of adults with HCM and OSA, GLP-1 RA exposure was associated with lower odds of MACE and improved long-term MACE-free survival.”
plaincorrelationaln = 4,930 ·- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Also stated in: § GLP-1 receptor agonist use and long-term outcomes in hypertrophic cardiomyopathy with obstructive sleep apnoea: A real-world cohort analysis · p. 1 · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“For acute heart failure hospitalisation (excluding prior such events), cumulative risk was 4.7% vs 5.1% (odds ratio or OR 0.92; p = 0.40); Cox proportional HR was 0.84 (95% CI 0.70 -1.02; log-rank p = 0.08).”
plainn = 4,930- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Probably not a substantial claim. 3
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“For arrhythmias (excluding prior events), cumulative risk was 12.8% vs 11.2% (OR 1.16; p = 0.04); Cox proportional HR was 1.07 (95% CI 0.93 -1.23; log-rank p = 0.38).”
plaincorrelationaln = 4,930 ·- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Before matching, cohort sizes were 4,962 (GLP-1 RA) and 36,249 (no GLP-1 RA); after matching, 4,930 patients were included in each cohort.”
plainn = 4,930- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Propensity score matching (1:1) was performed across 18 covariates (including age, sex, body mass index, and comorbidities).”
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
The paper relies on this without support.
OSA is prevalent in HCM.
“Obstructive sleep apnoea (OSA) is prevalent in hypertrophic cardiomyopathy (HCM) and may contribute to adverse cardiometabolic and cardiovascular outcomes.”
The paper relies on this without support.
OSA may contribute to adverse cardiometabolic and cardiovascular outcomes in HCM.
“Obstructive sleep apnoea (OSA) is prevalent in hypertrophic cardiomyopathy (HCM) and may contribute to adverse cardiometabolic and cardiovascular outcomes.”
The paper relies on this without support.
GLP-1 RAs are effective for cardiometabolic risk management.
“Although glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are effective for cardiometabolic risk management, their association with long-term outcomes in adults with HCM and OSA remains unclear.”
The paper relies on this without support.
The association between GLP-1 RA exposure and long-term outcomes in adults with HCM and OSA was unclear prior to this study.
“Although glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are effective for cardiometabolic risk management, their association with long-term outcomes in adults with HCM and OSA remains unclear.”
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Metadata
- Authors
- Shah, S., Abusafia, M., Sheashaa, H., Jadam, S., Ospina, S., Kaelber, D., Keen, S., & Desai, M.
- Affiliations
- Cleveland Clinic (US)
- MetroHealth Medical Center (US)
- Venue
- European Heart Journal
- Publisher
- Oxford University Press (OUP)
- Published
- 2026-10
- Volume
- 47
- Issue
- Supplement_1
- ISSN
- 0195-668X (ISSN-L)
- 1522-9645
- OpenAlex
- W7223563993
- Semantic Scholar
- 1e534c1363ba5f2829dc68275324b39eb8698fbc
- Cited by
- 0
- References
- 0
- FWCI
- 0.00
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- European Heart Journal (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiomyopathy and Myosin Studies
- Health Sciences › Medicine › Physiology (medical) › Obstructive Sleep Apnea Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Keywords
- hypertrophic cardiomyopathy, obstructive sleep apnea, GLP-1 receptor agonists, major adverse cardiovascular events, heart failure hospitalization, cardiac arrhythmias, atrial fibrillation, ventricular tachycardia, ventricular fibrillation, ischemic stroke, all-cause mortality, cardiometabolic risk, long-term outcomes, real-world evidence, propensity score matching
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