Glucagon-Like Peptide-1 Agonist Use in Adults With Congenital Heart Disease: Effect, Safety, and Outcomes.

BACKGROUND: Obesity is prevalent among patients with adult congenital heart disease (ACHD) and contributes to adverse cardiovascular outcomes. There is a paucity of data regarding glucagon-like peptide-1 receptor agonists (GLP-1 RA) for weight loss in patients with ACHD. OBJECTIVES: The purpose of this study was to assess the effect, safety, and outcomes of GLP-1 RA among patients with ACHD. METHODS: This is a retrospective cohort study of patients with ACHD at Mayo Clinic (January 2013-January 2024) who were prescribed semaglutide or liraglutide. The primary endpoint was weight loss. Secondary endpoints were changes in NYHA functional class, hemoglobin A1c, estimated glomerular filtration rate, and safety endpoints of renal adverse event, hypoglycemia, hospitalization/drug discontinuation due to side effects. RESULTS: Seventy patients received GLP-1 RA over a mean duration of 21 ± 20 months. Majority (85.7%) had moderate/severe complexity congenital heart disease. Weight loss >5% was achieved in 30 (42.9%) patients. Patients with body mass index ≥35 kg/mwere more likely to achieve weight loss >5% [66.7% vs 40%, P = 0.027]. Younger age resulted in improved weight loss of 0.17 kg per 1-year age difference (P = 0.014). Hemoglobin A1c lowered by a mean of 0.6% (P = 0.054). There were no significant changes in NYHA functional class or estimated glomerular filtration rate. One-third of patients experienced side effects, mostly from gastrointestinal intolerance (20%); 11.4% discontinued the medication due to side effects. CONCLUSIONS: GLP-1 RAs are safe and effective for weight loss in patients with ACHD with beneficial effects on glycemic control.