(PC046) Glucagon-Like Peptide-1 Receptor Agonists are Associated with Reduced Abdominal Aortic Aneurysm-Related Events

Objectives: Glucagon-like peptide 1 receptor agonists (GLP-1RAs) have shown to reduce major adverse cardiovascular events, with animal studies suggesting potential benefits in slowing abdominal aortic aneurysm (AAA) growth. However, their effect on AAA in human remains unexplored. This study investigates the effects of GLP-1RAs on the rates of all-cause mortality, AAA repair, and acute abdominal aortic syndrome (AAAS) in patients with unruptured AAA.

Methods: This retrospective cohort study utilized the US collaborative network of the TriNetX platform to identify patients aged ≥18 years with unruptured AAA, based on ICD-10 encounter diagnoses, between 01/01/2015 and 12/01/2019. Patients with a history of AAA rupture, dissection, repair and connective tissue disorders were excluded. The remaining cohort was stratified by type 2 diabetes (T2D) status and divided into two cohorts: GLP-1RA users who were prescribed GLP-1RAs within six months before or anytime after AAA diagnosis, and non-GLP-1RA users who were never prescribed GLP-1RAs. Propensity score matching (1:1) was performed to balance cohorts by demographics (age, gender, race/ethnicity), tobacco use, BMI, hemoglobin A1c levels, comorbidities, and medications (anti-lipemics, anti-hypertensives, metformin). Kaplan-Meier survival and risk analyses compared outcomes over a five-year follow-up.

Results: Of the 3,340 GLP-1RA users and 41,352 non-GLP-1RA users with T2D, 3,311 patients in each cohort were matched and analyzed. Similarly, among 805 GLP-1RA users and 125,423 non-GLP-1RA users without T2D, 800 patients were matched and analyzed. GLP-1RA users had significantly lower risks of the composite outcome of mortality, AAA repair, and acute abdominal aortic syndrome in both T2D (RR 0.48, 95% CI 0.44-0.53; p< 0.0001) and non-T2D cohorts (RR 0.29, 0.22-0.37; p< 0.0001). Specifically, GLP-1RA users had decreased mortality (T2D: RR 0.46, 0.41-0.50; p< 0.0001; non-T2D: RR 0.23, 0.16-0.32; p< 0.0001) and were less likely to undergo AAA repair (T2D: RR 0.42, 0.31-0.55; p< 0.0001; non-T2D: RR 0.29, 0.16-0.51; p< 0.0001). Among non-T2D patients, GLP-1RA users had a reduced risk of AAAS than non-GLP-1RA users (RR 0.45, 0.24–0.84; p=0.01), but no significant differences were observed in the T2D cohort (RR 0.77, 0.56–1.05; p=0.092). Kaplan-Meier analysis also demonstrated the benefits of GLP-1RAs in delaying AAA repair (Fig. 1 and 2).

Conclusions: GLP-1RAs were associated with reduced risk of AAA-related events and delay in AAA repair in patients with unruptured AAA, regardless of diabetes status. These findings suggest the potential benefits of GLP-1RAs in AAA management, warranting further research on their effects on aneurysm growth and progression.