Study Highlights Cardiopulmonary Benefits of GLP-1 RAs in Patients with Diabetes, OSA

Recent research has indicated that glucagon-like peptide-1 receptor agonists (GLP-1RAs) significantly reduce all-cause mortality and risk of cardiovascular outcomes in patients with type 2 diabetes mellitus (T2DM) and obstructive sleep apnea (OSA).1

Presented at the 9th Annual Heart in Diabetes Conference by Karldon Iwuchukwu Nwaezeapu, MD, a medical doctor at Trinity Health, and colleagues, this retrospective cohort study analyzed data from 533,694 patients with OSA and T2DM, collected via the TriNetX Global Collaborative Network.1

OSA is a well-known outcome of obesity, which predisposes individuals to collapse of the upper airway and increased work against higher levels of adipose tissue during ventilation of sleep. GLP-1RAs, despite initially being developed to assist in the glycemic control of T2DM, have also displayed consistent and durable results in weight loss.2

T2DM is an even more widespread condition, affecting roughly 1 in 10 adults globally. A variety of life-threatening complications are associated with the disease, including cardiovascular outcomes. To that end, GLP-1RAs have recently been pushed as the optimal treatment, triggering weight loss as well as promoting nerve growth, improving cardiac function, suppressing appetite, regulating lipid metabolism, and reducing fat deposition.3

“Glucagon-like peptide-1 receptor agonists have demonstrated cardiovascular benefits in various populations, but their effects specifically in patients with concurrent T2DM and OSA remain incompletely characterized,” wrote Nwaezeapu and colleagues.1

The team divided the 533,694 patients into 1 groups; one received GLP-1RAs, while the others were used as control. Each group consisted of 266,847 participants; the team followed up with each patient after a 10-year interval. Investigators noted the primary endpoint as all-cause mortality, with secondary endpoints including cardiovascular and pulmonary outcomes.1

Upon analysis, investigators found a 42.1% relative risk reduction in all-cause mortality with GLP-1 therapy use (risk ratio [RR], 0.579; 95% CI, 0.567-0.592; P <.001), additionally highlighting a 21% reduction in pulmonary hypertension in this group relative to the control group (RR, 0.790; 95% CI, 0.769-0.813; P <.001).1

Investigators also noted significant cardiovascular benefits in the GLP-1 RA group, calling attention to a 33.6% reduction in cardiogenic shock (RR, 0.664; 95% CI, 0.627-0.703; P <.001), a 12.6% reduction in acute MI (RR, 0.874; 95% CI, 0.849-0.899; P <.001), and a 17.6% reduction in ventricular tachycardia (RR, 0.824; 95% CI, 0.794-0.856; P <.001). Further analysis revealed additional reductions in atrial fibrillation (11%; RR, 0.890; 95% CI, 0.869-0.912; P <.001) and heart failure (7.3%; RR, 0.927; 95% CI, 0.910-0.946; P <.001) as well as a minimal increase in syncope and collapse (RR, 1.030; 95% CI, 1.005-1.054; P = .016).1

Collectively, the use of GLP-1RAs in patients with T2DM and OSA was associated with substantially reduced all-cause mortality, lower risk of cardiovascular outcomes, and a pulmonary hypertension reduction.1

“These findings suggest a favorably cardiopulmonary risk-benefit profile in this high-risk population, warranting further investigation through prospective randomized trials,” Nwaezeapu and colleagues wrote.1
References

1. Nwaezeapu K, Ajenaghughrure G, Essien E, Agyekum A. GLP-1 Receptor Agonists in Patients with Type 2 Diabetes Mellitus and Obstructive Sleep Apnea: Cardiovascular, Pulmonary, and Mortality Outcomes. Abstract presented at the 9th Annual Heart in Diabetes Conference in Philadelphia, PA, from June 6-8, 2025.

2. Le KDR, Le K, Foo F. The Impact of Glucagon-like Peptide 1 Receptor Agonists on Obstructive Sleep Apnoea: A Scoping Review. Pharmacy (Basel). 2024;12(1):11. Published 2024 Jan 8. doi:10.3390/pharmacy12010011

3. Majety P, Lozada Orquera FA, Edem D, Hamdy O. Pharmacological approaches to the prevention of type 2 diabetes mellitus. Front Endocrinol (Lausanne). 2023;14:1118848. Published 2023 Mar 9. doi:10.3389/fendo.2023.1118848