GLP-1 receptor agonist therapy and incident atrial fibrillation in non-diabetic adults with obesity and chronic kidney disease: a propensity matched cohort study
- Design
- Retrospective cohort · 14652 participants · Hard outcome
- Match to healthy normal-weight adults aged 55–75
- Different populationINDIRECT: all participants had obesity and CKD stages 3-5 (diabetes excluded); mean age and BMI are not reported.
- Could weight loss explain it?
- PossiblyObesity is a stated AF risk factor, and the abstract reports no weight, blood-pressure or glycaemic change and no analysis separating weight loss from a direct drug effect; propensity score matching addresses baseline confounding only.
- Study tier
- Study tier 3LOW: single retrospective cohort (target trial emulation) in TriNetX records; the observational design caps the tier.
- Assessment
- Version 4 · Two reviewers differed; settled by a recorded ruling · Oct 19, 2026
Study facts come from the paper. Population match, weight-loss explanation and study tier are our judgments, made against the reference group of healthy normal-weight adults aged 55–75.
This study used US health records (TriNetX) to compare non-diabetic adults with obesity and chronic kidney disease who took semaglutide, liraglutide or tirzepatide with similar people who did not, with 7326 matched patients per group. GLP-1 drug use was linked to less new atrial fibrillation at 1 year (1.63% vs. 2.62%; HR 0.655, 95% CI 0.508-0.844) and to fewer ventricular arrhythmias and hospitalizations, while permanent AF did not differ significantly. Because the study is observational, these are associations, not proof that the drugs prevented AF.
01Findings
What the study reported
- Drugs
- Semaglutide, Liraglutide, Tirzepatide
- Comparator
- unexposed patients
- Primary outcome
- incident atrial fibrillation at 1 year
- Effect
- Incident AF at 1 year 1.63% vs. 2.62% (HR 0.655); paroxysmal HR 0.586, persistent HR 0.482, longstanding persistent HR 0.527; permanent AF non-significant at 1 year; ventricular tachyarrhythmias HR 0.556; hospitalization HR 0.668
- 95% confidence interval
- 95% CI 0.508-0.844
- P value
- p = 0.001
- Follow-up
- 1 year (sensitivity analyses extended follow-up to 2-3 years)
- Adverse events
- not reported in abstract
- Limitations
- Retrospective target trial emulation in health-record data compared with unexposed patients, so residual confounding is possible; the primary outcome was at 1 year, and the authors call for dedicated randomized trials.
Who was studied
- Age min
- 18
- Obesity status
- obesity required (criterion not stated)
- Diabetes status
- excluded (non-diabetic)
- Cvd status
- not reported in abstract
- Ckd status
- CKD stages 3-5 required
- Baseline condition
- obesity with CKD stages 3-5, without diabetes
- Sample size
- 14652
- Inclusion exclusion
- non-diabetic adults aged 18 or older with obesity and CKD stages 3-5 diagnosed 2021-2024 (TriNetX)
Study quality details
- Study design
- Retrospective cohort
- Sample size
- 14652
- Randomization
- no
- Blinding
- n/a
- Comparator
- unexposed patients
- Follow up duration
- 1 year (sensitivity analyses extended follow-up to 2-3 years)
- Outcome type
- hard
- Replication
- not assessed
- Consistency with other evidence
- not assessed
- Population applicability
- INDIRECT
- Statistical precision
- CI reported: 95% CI 0.508-0.844
- Risk of bias
- not assessed
- Funding conflicts
- unclear
- Peer review status
- yes
02Funding
Funding and conflicts
- Funding
- not reported in abstract
- Industry funded
- Unclear
- Manufacturer
- not stated in source
- Sponsor role
- not reported in abstract
- Author conflicts
- All authors declare no conflicts of interest.
- Independent replication
- unknown
Funding is shown on every study and never used to score it.
04Source
The source, as retrieved
Abstract
[BACKGROUND] Obesity and chronic kidney disease (CKD) are potent risk factors for atrial fibrillation (AF), yet whether GLP-1 receptor agonists (GLP-1RAs) prevent incident AF in non-diabetic adults with obesity and CKD is unexamined. We assessed whether GLP-1RA therapy reduces 1-year AF incidence in this cardiorenal phenotype. [METHODS] Using the TriNetX US Collaborative Network (66 healthcare organizations), we conducted a retrospective target trial emulation of non-diabetic adults aged 18 or older with obesity and CKD stages 3-5 diagnosed 2021-2024. Patients receiving semaglutide, liraglutide, or tirzepatide (n = 10,985) were compared with unexposed patients (n = 94,527). After propensity score matching, 7326 patients remained per cohort. The primary outcome was incident AF at 1 year; secondary outcomes included AF subtypes, ventricular tachyarrhythmias, and all-cause hospitalization. Cox models generated hazard ratios (HRs); sensitivity analyses extended follow-up to 2-3 years with landmark analyses. [RESULTS] At 1 year, GLP-1RA use was associated with significantly lower incident AF (1.63% vs. 2.62%; HR 0.655, 95% CI 0.508-0.844; p = 0.001), a 34.5% relative risk reduction. Reductions were consistent for paroxysmal (HR 0.586), persistent (HR 0.482), and longstanding persistent AF (HR 0.527; all p < 0.05); permanent AF was non-significant at 1 year. Ventricular tachyarrhythmias (HR 0.556; p = 0.002) and hospitalization (HR 0.668; p < 0.001) were also significantly reduced. Benefits persisted across 2- and 3-year follow-up and remained consistent in landmark analyses. [CONCLUSIONS] In non-diabetic adults with obesity and CKD, GLP-1RA therapy was associated with significant, durable reductions in incident AF, ventricular arrhythmias, and hospitalization. These findings are consistent with a possible cardiorenal benefit and support prioritizing this phenotype for dedicated randomized trials.
Where this record came from
| Source | Retrieved | Identifier |
|---|---|---|
| pubmed | Oct 18, 2026 | 42892471 first ingestion |