AHA Scientific Sessions 2026 Abstract · Nov 2, 2026
Disparities in Glucagon-Like Peptide-1 Receptor Agonist Use Among Adults with Schizophrenia and Obesity
By Rossi R, Ibrahim S, Costa M et al.
Introduction: Temporal trend analyses suggest that cardiovascular mortality among individuals with severe mental illness, including schizophrenia, has dramatically increased since the 1990s, with more than 30% of them meeting criteria for metabolic syndrome. While glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are increasingly recognized as promising therapies for metabolic dysfunction, real-world prescribing patterns associated with GLP-1 RA use in this high-risk population remain poorly characterized. Research Question: This study evaluated the prevalence of elevated BMI among individuals with schizophrenia receiving antipsychotics and assessed GLP-1RA prescribing patterns compared to the general population. Methods: This retrospective cohort study used the TriNetX Research Network to assess the prevalence of overweight and obesity and characterize metabolic burden among adults with schizophrenia receiving antipsychotic therapy between 2010 and 2025. Prevalence was defined as documented overweight/obesity at any point during the study period. To evaluate GLP1-RA prescribing disparities, adults with overweight/obesity and schizophrenia were propensity-matched to adults with overweight/obesity without schizophrenia from the general population on age, sex, race/ethnicity, diabetes status, and cardiovascular comorbidities. GLP-1RA prescribing rates between groups were compared using chi-square tests, and multivariable logistic regression. Results: Among 705,804 adults with schizophrenia receiving antipsychotic therapy between 2010 and 2025, obesity/overweight prevalence was high at 58.5%, with the greatest burden observed among adults aged 40-44 years (66.7%), women (63.8% vs 54.1% in men), and Native Hawaiian or Other Pacific Islander and Black/African American individuals. Even after matching, individuals with schizophrenia demonstrated a substantial cardiometabolic burden, compared with matched controls. Despite a greater cardiometabolic burden, in propensity score-matched analyses of adults with overweight/obesity, patients with schizophrenia were significantly less likely to receive GLP-1RAs than matched controls without schizophrenia at both 5 years, corresponding to approximately 25% lower risk of GLP-1RA exposure (RR 0.75, 95% CI 0.73-0.77), and 10 years, approximately 32% lower risk of GLP-1RA exposure (RR 0.68, 95% CI 0.66-0.69). (Figure 1) Conclusion: These findings highlight the substantial burden of overweight and obesity among individuals with schizophrenia treated with antipsychotics, particularly among women and racial minority groups. Despite this elevated risk profile, individuals with schizophrenia were significantly less likely to receive GLP-1RA therapy. Potential barriers include access issues, fragmented care, and therapeutic underutilization in serious mental illness.