Association of GLP-1 Receptor Agonist and SGLT2 Inhibitor With Cardiovascular Outcomes After Transcatheter Aortic Valve Replacement

Aortic valve disease is the most common valvular disease and is often seen in the elderly population. Transcatheter aortic valve replacement (TAVR) is a favorable and rapidly evolving intervention. Despite highly effective procedural outcomes, the TAVR population remains at high risk for heart failure and death, and medical therapy after TAVR is understudied. Diabetic medications including GLP-1 receptor agonists (GLP-1 RA) and SGLT2 inhibitors (SGLT2i) have had emerging data suggesting cardioprotective effects. In this study, we aim to evaluate cardiovascular outcomes in post-TAVR patients who are treated with GLP-1 RA, SGLT2i, or both compared to those who are not treated. Using TriNetX, we identified a cohort of patients who underwent a TAVR procedure and then classified them as treated with GLP-1 RA, SGLT2i, both, or none. After propensity matching for demographics, comorbidities, and medications, patient outcomes for all-cause mortality (ACM) and cardiovascular disorders were evaluated using a Kaplan-Meier analysis. Our results showed a decrease in ACM in those who were on GLP-1 RA after TAVR compared to those who were not. There was also a statistically significant decrease in arrhythmia in patients on SGLT2i after TAVR compared to those who were not. When GLP-1 RA and SGLT2i were combined, there was a decrease in ACM, myocardial infarction, acute heart failure, and arrhythmia after TAVR compared to those who were not. In conclusion, these findings further suggest cardioprotective effects of these drugs in patients treated with TAVR. Future trials should further investigate the role of these medications in patients with aortic valve stenosis.