GLP-1s and the HCM–Sleep Apnea–Obesity Connection

In an interview with Pharmacy Times, Milind Desai, MD, MBA, FACC, FAHA, FESC, vice chair of the Heart Vascular Thoracic Institute and director of the Hypertrophic Cardiomyopathy Center at the Cleveland Clinic, discussed why his team examined glucagon-like peptide-1 (GLP-1) receptor agonist exposure in patients living with both hypertrophic cardiomyopathy (HCM) and obstructive sleep apnea and the cardiovascular outcomes that emerged. The research was published in the Journal of the American College of Cardiology and presented at the European Society of Cardiology 2026 Congress in Munich, Germany.¹

Desai explained that HCM has a strong, well-recognized association with obstructive sleep apnea and that the pairing has long been a source of clinical and academic curiosity for him. Rather than stopping at the association, his group wanted to understand its downstream ramifications, particularly around medication exposure. He framed the analysis around a chain of interrelated risks: obstructive sleep apnea places substantial pressure on the heart and raises the risk of arrhythmias, especially atrial fibrillation; HCM that is not well managed can worsen outcomes; and obesity, which can itself drive obstructive sleep apnea, is now increasingly treatable.

The hypothesis was whether patients with obesity, obstructive sleep apnea, and HCM who were exposed to GLP-1 receptor agonists would fare better than a propensity-matched group who were not. Using a large real-world database, the team matched roughly 5372 patients in each arm for comorbidities, indexed exposure to one day after GLP-1 approval, and followed patients for about 3650 days—roughly 10 years. Major adverse cardiac events, defined by standard ICD-10 criteria, included death, stroke, and acute myocardial infarction. Desai reported that composite outcomes were significantly better in the GLP-1 group, with the benefit driven largely by reduced mortality; there was no significant difference in stroke, MI, or heart failure admission.¹

For pharmacists, the analysis signals a potential role for GLP-1 therapy in a high-risk cardiometabolic population, while underscoring that these are early, registry-based findings.

REFERENCE

Halpern L. GLP-1 agonists tied to lower mortality in HCM with sleep apnea. Pharmacy Times. Published September 3, 2026. Accessed September 4, 2026. https://www.pharmacytimes.com/view/glp-1-agonists-tied-to-lower-mortality-in-hcm-with-sleep-apnea