People with cardiac transthyretin amyloidosis (ATTR-CM) may live longer and experience fewer serious heart problems when treated with a combination of two medications: GLP-1 receptor agonists (GLP-1RAs) and sodium-glucose cotransporter 2 inhibitors (SGLT2is), according to results from a study published recently in the International Journal of Cardiology.
GLP-1RAs are a class of medications usually used to control blood sugar levels in patients with diabetes and to promote weight loss. The category includes the medication semaglutide (marketed as Ozempic and Wegovy). SGLT2is are a class of medications also often used to treat diabetes; previous research indicates they can provide heart benefits in patients with ATTR-CM.
In this large study of more than 5,000 patients with ATTR-CM, those who took both medicines had lower death rates, fewer major cardiovascular events, and fewer hospital visits over 12 months compared with those who took only SGLT2is.
Among 5,120 patients, 845 received both drugs, while the other 4,275 took only SGLT2is. After adjusting for differences in age, body weight and other health issues such as high blood pressure and type 2 diabetes, researchers matched 729 patients in each group. The matched groups had similar health backgrounds, making the outcome comparisons more reliable.
“This retrospective study provides valuable real-world evidence supporting the potential added benefit of GLP-1RA therapy in patients with ATTR-CA on SGLT2i therapy,” explained this study’s authors. They continued, “Prospective randomized controlled trials are warranted to validate these findings.”
Read more about ATTR-CM prognosis and staging
At one year, patients taking both GLP-1RAs and SGLT2is had significantly better results. Only 1.8% of these patients died during the study period, compared with 5.5% in the SGLT2i-only group. Major heart problems such as heart attacks and strokes, which are known collectively as major adverse cardiovascular events, or MACE, occurred less often in the combination group as well (14.0% vs 19.3%).
The benefits went beyond survival. People taking both medicines also had fewer strokes (8.0% vs 11.3%), fewer worsening heart failure episodes (19.1% vs 29.0%) and fewer hospitalizations overall (24.8% vs 30.6%). Importantly, the combination therapy did not increase the risk of developing new heart rhythm issues like atrial fibrillation or ventricular arrhythmias.
While both GLP-1RAs and SGLT2is have known benefits in heart disease and diabetes, their combined effect in ATTR-CM had not been fully studied until now.
For patients living with ATTR-CM, this research offers hope for better outcomes through existing therapies. Doctors may consider this combination approach to reduce serious complications and improve quality of life in this complex disease.
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