Glucagon‐like peptide‐1 receptor agonist semaglutide reduces atrial fibrillation incidence: A systematic review and meta‐analysis

Author:

Saglietto Andrea123ORCID,Falasconi Giulio345,Penela Diego35,Francia Pietro36,Sau Arunashis78,Ng Fu Siong789,Dusi Veronica12,Castagno Davide12,Gaita Fiorenzo210,Berruezo Antonio3,De Ferrari Gaetano Maria12,Anselmino Matteo12

Affiliation:

1. Division of Cardiology, Cardiovascular and Thoracic Department "Citta della Salute e della Scienza" Hospital Turin Italy

2. Department of Medical Sciences University of Turin Turin Italy

3. Heart Institute Teknon Medical Centre Barcelona Spain

4. Campus Clínic University of Barcelona Barcelona Spain

5. Arrhythmology Department IRCCS Humanitas Research Hospital Rozzano Italy

6. Division of Cardiology, Department of Clinical and Molecular Medicine, St. Andrea Hospital Sapienza University

7. National Heart and Lung Institute Hammersmith Campus, Imperial College London London UK

8. Department of Cardiology Hammersmith Hospital, Imperial College Healthcare NHS Trust London UK

9. Department of Cardiology Chelsea and Westminster Hospital NHS Foundation Trust London UK

10. Cardiology Unit J Medical Turin Italy

Abstract

AbstractBackgroundGlucagon‐like peptide‐1 receptor agonists (GLP‐1 RAs) are new anti‐hyperglycaemic drugs with proven cardiovascular (CV) benefit in diabetic and non‐diabetic patients at high CV risk. Despite a neutral class effect on arrhythmia risk, data on semaglutide suggest a possible drug‐specific benefit in reducing atrial fibrillation (AF) occurrence.ObjectiveTo perform a meta‐analysis of randomized clinical trials (RCTs) to assess the risk of incident AF in patients treated with semaglutide compared to placebo.Methods and ResultsTen RCTs were included in the analysis. Study population encompassed 12,651 patients (7285 in semaglutide and 5366 in placebo arms), with median follow‐up of 68 months. A random effect meta‐analytic model was adopted to pool relative risk (RR) of incident AF. Semaglutide reduces the risk of AF by 42% (RR .58, 95% CI .40–.85), with low heterogeneity across the studies (I2 0%). At subgroup analysis, no differences emerged between oral and subcutaneous administration (oral: RR .53, 95% CI .23–1.24, I2 0%; subcutaneous: RR .59, 95% CI .39–.91, I2 0%; p‐value .83). In addition, meta‐regression analyses did not show any potential influence of baseline study covariates, in particular the proportion of diabetic patients (p‐value .14) and body mass index (BMI) (p‐value .60).ConclusionsSemaglutide significantly reduces the occurrence of incident AF by 42% as compared to placebo in individuals at high CV risk, mainly affected by type 2 diabetes mellitus. This effect appears to be consistent independently of the route of administration of the drug (oral or subcutaneous), the presence of underlying diabetes and BMI.

Publisher

Wiley

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