Glucagon-like peptide-1 receptor agonists and the risk of ventricular arrhythmia in patients with acute myocardial infarction and type 2 diabetes mellitus: a propensity score-matched cohort study.
- 1Department of Cardiology, 920th Hospital of the Joint Logistics Support Force, Kunming City, Yunnan, 650032, China.
- 2Department of Cardiovascular Medicine, Hospital No. 922, Joint Logistics Support Force, Hengyang City, Hunan, 421200, China.
- 3Department of Cardiology, 920th and 922nd Hospital of Joint Logistics Support Force, PLA, No. 212, Daguan Road, Kunming, Yunnan, 650032, China. [email protected].
Abstract
Background
Ventricular arrhythmia (VA) substantially contributes to sudden cardiac death in patients with acute myocardial infarction (AMI) and type 2 diabetes mellitus (T2DM). Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have demonstrated cardiovascular benefits; however, their influence on post-AMI ventricular arrhythmogenesis remains unclear.Methods
This retrospective cohort study included 1,873 patients with concurrent AMI and T2DM admitted between January 2018 and December 2022. Using propensity score matching (1:2, nearest-neighbor), 277 GLP-1RA users were matched with 554 controls. The primary endpoint was incident VA. Cox proportional hazards regression, inverse probability of treatment weighting (IPTW), Firth's penalized likelihood regression, and Fine-Gray competing risk analysis were performed.Results
Over a median follow-up of 2.5 years, GLP-1RA use was associated with a reduced risk of VA (adjusted HR 0.61, 95% CI 0.37-0.98, P = 0.040), MACE (HR 0.66, 95% CI 0.45-0.96, P = 0.030), cardiovascular death (HR 0.52, 95% CI 0.32-0.86, P = 0.010), and heart failure rehospitalization (HR 0.42, 95% CI 0.26-0.68, P < 0.001). All-cause mortality showed a non-significant trend (HR 0.84, 95% CI 0.59-1.18, P = 0.310). Firth's penalized regression confirmed the primary finding (HR 0.58, 95% CI 0.36-0.95, P = 0.029). The Fine-Gray model yielded a subdistribution HR of 0.63 (95% CI 0.39-1.02, P = 0.058) after accounting for competing mortality risk. The 90-day landmark analysis (HR 0.65, 95% CI 0.39-1.06, P = 0.085) and the time-varying exposure Cox model (HR 0.66, 95% CI 0.40-1.08, P = 0.097) were directionally concordant but did not reach statistical significance.Conclusions
GLP-1RA therapy was associated with a lower risk of VA and improved cardiovascular outcomes in patients with AMI and T2DM. Because several sensitivity analyses, including the Fine-Gray competing-risk, landmark, and time-varying models, were borderline non-significant, these findings should be interpreted with caution and regarded as hypothesis-generating, warranting confirmation in prospective randomized trials.
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BibTeX
@article{hu2026glucagonlike,
title = {{Glucagon-like peptide-1 receptor agonists and the risk of ventricular arrhythmia in patients with acute myocardial infarction and type 2 diabetes mellitus: a propensity score-matched cohort study.}},
author = {Chunqin Hu and Wenming Zhao and Shasha Xiao and Jiujiu Shi and Wenhua Liang and Ruiwei Guo},
journal = {BMC cardiovascular disorders},
year = {2026},
month = aug,
doi = {10.1186/s12872-026-06354-y},
url = {https://europepmc.org/article/MED/42958020},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Glucagon-like peptide-1 receptor agonists and the risk of ventricular arrhythmia in patients with acute myocardial infarction and type 2 diabetes mellitus: a propensity score-matched cohort study.
AU - Chunqin Hu
AU - Wenming Zhao
AU - Shasha Xiao
AU - Jiujiu Shi
AU - Wenhua Liang
AU - Ruiwei Guo
PY - 2026
DA - 2026/08/03
JO - BMC cardiovascular disorders
DO - 10.1186/s12872-026-06354-y
UR - https://europepmc.org/article/MED/42958020
AB - Background Ventricular arrhythmia (VA) substantially contributes to sudden cardiac death in patients with acute myocardial infarction (AMI) and type 2 diabetes mellitus (T2DM). Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have demonstrated cardiovascular benefits; however, their influence on post-AMI ventricular arrhythmogenesis remains unclear.Methods This retrospective cohort study included 1,873 patients with concurrent AMI and T2DM admitted between January 2018 and December 2022. Using propensity score matching (1:2, nearest-neighbor), 277 GLP-1RA users were matched with 554 controls. The primary endpoint was incident VA. Cox proportional hazards regression, inverse probability of treatment weighting (IPTW), Firth's penalized likelihood regression, and Fine-Gray competing risk analysis were performed.Results Over a median follow-up of 2.5 years, GLP-1RA use was associated with a reduced risk of VA (adjusted HR 0.61, 95% CI 0.37-0.98, P = 0.040), MACE (HR 0.66, 95% CI 0.45-0.96, P = 0.030), cardiovascular death (HR 0.52, 95% CI 0.32-0.86, P = 0.010), and heart failure rehospitalization (HR 0.42, 95% CI 0.26-0.68, P < 0.001). All-cause mortality showed a non-significant trend (HR 0.84, 95% CI 0.59-1.18, P = 0.310). Firth's penalized regression confirmed the primary finding (HR 0.58, 95% CI 0.36-0.95, P = 0.029). The Fine-Gray model yielded a subdistribution HR of 0.63 (95% CI 0.39-1.02, P = 0.058) after accounting for competing mortality risk. The 90-day landmark analysis (HR 0.65, 95% CI 0.39-1.06, P = 0.085) and the time-varying exposure Cox model (HR 0.66, 95% CI 0.40-1.08, P = 0.097) were directionally concordant but did not reach statistical significance.Conclusions GLP-1RA therapy was associated with a lower risk of VA and improved cardiovascular outcomes in patients with AMI and T2DM. Because several sensitivity analyses, including the Fine-Gray competing-risk, landmark, and time-varying models, were borderline non-significant, these findings should be interpreted with caution and regarded as hypothesis-generating, warranting confirmation in prospective randomized trials.
SN - 1471-2261
ER -