GLP-1 RA and Atrial Fibrillation in the Cardiovascular Outcome Trials.

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. This article is protected by copyright. All rights reserved.