Safety and Efficacy of GLP-1 Agonists in a Cohort of Patients with Fontan Circulation

There are a growing number of adult patients palliated to a Fontan circulation. As these patients age, many develop symptomatic heart failure (d’Udekem et al in Circulation 130:S32–S38, 2014) that is exacerbated by acquired comorbidities such as obesity and hypertension. Increased body mass index (BMI) and adiposity have been associated with worse hemodynamics and clinical outcomes in these patients (Yogeswaran et al in J Am Hear Assoc: Cardiovasc Cerebrovasc Dis 12:e026732, 2023). Recently, glucagon-like peptide-1 (GLP-1) agonists, originally developed to treat diabetes mellitus, received FDA approval for weight loss and have been shown to reduce the risk of cardiovascular events in the general population (Vilsbøll et al in BMJ 344:d7771, 2012). There are limited data on these medications in patients with a Fontan circulation. We conducted a retrospective review of adults with Fontan circulation followed in our adult congenital heart disease (ACHD) clinic between 2009 and 2023 and identified 8 patients prescribed GLP-1 agonists. We found that GLP-1 agonists were well-tolerated and led to modest reduction in weight and blood pressure. Further study of the use of these medications in this population is warranted.