NEW research has shown that the use of GLP-1 receptor agonists is associated with a significant reduction in major adverse cardiovascular and cerebrovascular events, all-cause mortality, heart failure, and kidney complications in patients with monoclonal gammopathy of undetermined significance and type 2 diabetes.
Monoclonal gammopathy of undetermined significance (MGUS) is a common precursor to blood cancers and is linked to increased cardiovascular risk, while type 2 diabetes is itself a major risk factor for cardiovascular and renal disease. GLP-1 receptor agonists, a class of diabetes medication, have well-established cardiorenal benefits in the general diabetic population, but their effectiveness in people with MGUS has not been previously studied.
This retrospective cohort study analysed data from 4,871 patients with both MGUS and type 2 diabetes, identified from the TriNetX Global Database between 2018 and 2023. Patients with a history of heart failure, ischaemic heart disease, coronary revascularisation, or stroke before their MGUS diagnosis were excluded to focus on primary prevention. After 1:1 propensity score matching, 460 GLP-1 RA users were compared with 460 non-users, with both groups well matched for age, sex, and ethnicity. The primary outcome was the occurrence of major adverse cardiovascular and cerebrovascular events (MACCE), defined as a composite of all-cause mortality, new-onset heart failure, acute coronary syndrome, and stroke or transient ischaemic attack. Over a median follow-up of 3.2 years, GLP-1 RA use was associated with a significantly lower risk of MACCE (hazard ratio 0.75; 95% CI, 0.60–0.93), all-cause mortality (HR 0.57; 95% CI, 0.37–0.87), new-onset heart failure (HR 0.69; 95% CI, 0.54–0.90), decompensated heart failure (HR 0.60; 95% CI, 0.43–0.84), and acute kidney injury or end-stage kidney disease (HR 0.73; 95% CI, 0.57–0.92).
These findings suggest that GLP-1 receptor agonists may offer important primary prevention benefits for cardiovascular and renal complications in patients with MGUS and diabetes, a group at particularly high risk. For clinical practice, this supports the consideration of GLP-1 RAs not only for glycaemic control but also for broader cardiorenal protection in this population.
Reference
Chi K et al. GLP-1 RA use and major adverse cardiovascular events in patients with monoclonal gammopathy of undetermined significance. JAMA Netw Open. 2025;8(6):e2517541.
