GLP-1 RAs, SGLT2 inhibitors, and RAAS inhibitors improve TAA survival and MACE-free survival.

Thoracic Aortic Aneurysm (TAA) remains a high-risk vascular condition, despite advancements in imaging, surgical repair, and endovascular therapies. Current medical management primarily focuses on blood pressure control and general cardiovascular risk reduction, often utilizing Renin-Angiotensin-Aldosterone System (RAAS) inhibitors. However, comprehensive data on the long-term survival and cardiovascular outcomes for RAAS inhibitors in broad TAA populations are limited. Furthermore, while Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and Sodium-glucose cotransporter-2 inhibitors (SGLT2 inhibitors) have established cardiometabolic benefits, their specific role in TAA management has not been well-defined, representing a significant gap in therapeutic strategies.

Researchers conducted a retrospective multicenter cohort study involving 162,126 adults diagnosed with imaging-confirmed Thoracic Aortic Aneurysm (TAA) between January 1, 2018, and January 1, 2026, utilizing a vast Mayo Clinic electronic data platform. The primary exposures were documented use of RAAS inhibitors, GLP-1 RAs, and SGLT2 inhibitors, analyzed both individually and in prespecified combination therapies. Propensity score matching was meticulously applied to balance demographics, comorbidities, aortic procedural history, and concomitant cardiovascular medications across groups. Primary outcomes assessed were all-cause mortality and major adverse cardiovascular events (MACE) through a 60-month follow-up period.

The study, encompassing 162,126 TAA patients, revealed significant associations between cardiometabolic and RAAS-targeted therapies and improved outcomes. After propensity matching, RAAS inhibitor use was linked to a higher 60-month overall survival rate of 88.3% compared to 85.5% (hazard ratio [HR], 0.79; 95% CI, 0.76-0.83; p < 0.001), and improved MACE-free survival (86.1% vs. 84.2%; HR, 0.87; 95% CI, 0.83-0.91; p < 0.001). GLP-1 RA therapy demonstrated a notably strong association with superior outcomes:

GLP-1 RA therapy was associated with a substantially higher overall survival of 97.5% versus 92.5% (HR, 0.32; 95% CI, 0.27-0.38; p < 0.001), and improved MACE-free survival (93.2% vs. 89.3%; HR, 0.62; 95% CI, 0.56-0.70; p < 0.001). Similarly, SGLT2 inhibitor therapy was associated with higher overall survival (89.8% vs. 81.5%; HR, 0.51; 95% CI, 0.47-0.54; p < 0.001) and MACE-free survival (86.1% vs. 80.0%; HR, 0.66; 95% CI, 0.62-0.70; p < 0.001). These findings highlight the potential of these drug classes in improving long-term prognosis for TAA patients.