AHA Scientific Sessions 2026 Abstract · Nov 2, 2026
Association of GLP-1 Receptor Agonists Use with Stroke Risk in Patients with Atrial Fibrillation
By Razaghi M, Bismee N, Abbas MT et al.
Background: Atrial fibrillation (AF) is the most common cause of cardioembolic stroke, affecting approximately one in every 3-5 individuals over the age of 45. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have independently demonstrated reductions in AF risk and ischemic stroke risk in broader populations, however their effect on stroke outcomes in AF patients remains relatively unknown. Hypothesis: We hypothesized that GLP-1RA treatment would be associated with a lower risk of stroke/transient ischemic attack (TIA) compared with no GLP-1RA therapy in patients with AF. Methods: This retrospective cohort study included all adult patients diagnosed with AF across three Mayo Clinic sites (Arizona, Florida, and Minnesota) from May 1998 to December 2017. The primary outcome was stroke/transient ischemic attack (TIA). GLP-1RA exposure was assessed both as a baseline characteristic and as a time-varying covariate. Outcomes were assessed through Kaplan-Meier analyses and multivariable Cox proportional hazards models, adjusted for CHA ₂ DS ₂ -VASc score and body mass index change (ΔBMI). Results: Among 7,994 patients with AF (mean age 72.11 ± 10.06 years; 56.6% male), 397 (4.97%) received GLP-1RAs. Over 10-year follow-up, Kaplan-Meier analysis showed significantly higher event-free survival in the GLP-1RA group vs. non-GLP-1RA group (85.9% vs. 73.6%; log-rank p<0.001), Figure. In multivariable Cox regression, GLP-1RA use was associated with a 58% reduction in stroke/TIA risk (HR 0.42, 95% CI 0.28-0.64; p<0.001). However, in time-varying Cox models, this association was attenuated and no longer statistically significant (HR 1.06, 95% CI 0.70-1.62; p=0.77). Conclusions: GLP-1RAs were associated with lower stroke/TIA risk in patients with AF in conventional multivariable analyses; however, this association was attenuated in time-varying models. These results highlight a potential long-term role for GLP-1RAs in this high-risk population, warranting additional future studies to confirm these findings.