GLP-1 RAs were associated with a 28% lower risk of developing PH in adults with diabetes. The study in Circulation compared new users of GLP-1 RAs with new users of dipeptidyl peptidase-4 inhibitors (DPP-4is) using a retrospective cohort design.

The analysis used Veterans Health Administration data from 2007 to 2021. A total of 4,109 GLP-1 RA users and 7,384 DPP-4i users had baseline transthoracic echocardiograms (TTEs) without PH, defined as right ventricular systolic pressure (RVSP) greater than 35 mm Hg, and at least one follow-up TTE.

Inverse probability weighting (IPW) achieved balance for demographics, comorbidities, vital signs, laboratory values, and medications. GLP-1 RA exposure was associated with a hazard ratio (HR) of 0.72 with a 95% confidence interval (CI) of 0.61 to 0.84. Unadjusted PH incidence rates were 54.8 versus 69.7 cases per 1,000 person-years. The risk reduction remained consistent across sensitivity analyses and in subgroups stratified by obesity, heart failure (HF) status, and diabetes severity.

These findings indicate that GLP-1 RA therapy is associated with lower PH risk and warrant further evaluation through randomized clinical trials.