Adults with a body mass index of 30 or above and C-reactive protein of 3 to 10 mg/L who received a GLP-1 receptor agonist were matched one to one with adults receiving metformin, orlistat or phentermine in the TriNetX electronic health record network, 50,009 in each arm, followed for up to ten years. The composite of death, acute myocardial infarction and ischaemic stroke was lower with GLP-1 exposure (HR 0.80, 95% CI 0.77-0.83), driven by all-cause mortality (HR 0.61, 0.58-0.64). Ischaemic stroke, arrhythmias and heart failure with reduced ejection fraction were modestly lower, while myocardial infarction did not differ.
Why it is interesting: The mortality hazard ratio is far larger than any randomised trial has shown and the infarction result is null, so the gap between the two is the thing to weigh.