GLP‐1 RA and atrial fibrillation in the cardiovascular outcome trials

Abstract

Introduction Type 2 diabetes is known as an independent risk factor for atrial fibrillation. While glucagon‐like peptide‐1 receptor agonists (GLP‐1 RAs) have demonstrated multiple cardiovascular effects, including decrease in blood pressure and total cholesterol, their use was associated with an increase in heart rate. Furthermore, in a participant level meta‐analysis evaluating albiglutide in the Harmony program, there were more participants who had atrial fibrillation or atrial flutter in the albiglutide‐treated group. This has raised a concern about the use of GLP‐1 RAs in individuals with type 2 diabetes who are at risk for developing atrial fibrillation. Methods The cardiovascular outcome trials (CVOT) comparing GLP‐1RA to placebo in individuals with type 2 diabetes and reported the incidence of atrial fibrillation as a serious adverse event were included. The primary outcome was to explore the incidence of atrial fibrillation reported as a serious adverse event. Results : We included LEADER, SUSTAIN‐6, REWIND, HARMONY, ELIXA, and PIONEER‐6. While EXCSEL met our initial inclusion criteria, the incidence of atrial fibrillation was not reported as a serious adverse event. Pooled results showed no significant difference between GLP‐1RA and placebo on the incidence of atrial fibrillation in individuals with type 2 diabetes (RR [95% CI] = 0.93 [0.70, 1.23], I²=58%) Conclusion This review suggests that there was no significantly increased risk of incident atrial fibrillation in individuals treated with GLP‐1 RAs when compared to placebo, among individuals with type 2 diabetes who either have increased cardiovascular risk or established cardiovascular disease.