Regression of microalbuminuria predicts cardiovascular risk reduction with GLP-1 receptor agonist therapy
L Cruz, A Taveras Franco, S Vasquez, I FigueroaAbstract
Background
GLP-1 receptor agonists (GLP-1 RAs) are established for weight and glycemic control and reduce cardiovascular risk in large trials, yet early renal biomarkers as predictors of cardiovascular benefit remain underexplored. Microalbuminuria (uACR) reflects endothelial dysfunction and renal injury, but its role in guiding cardiovascular risk stratification under GLP-1 therapy is unknown.
Purpose
To evaluate whether regression of microalbuminuria predicts cardiovascular outcomes in patients receiving GLP-1 RA therapy.
Methods
We retrospectively analyzed 1,261 Hispanic adults prescribed GLP-1 RAs (semaglutide, tirzepatide, liraglutide). Microalbuminuria was measured at baseline, 12, and 24 months. Patients were classified as regressors (≥30% uACR reduction at 24 months) versus progressors. The primary outcome was major adverse cardiovascular events (MACE: MI or stroke). Relative risks (RR) and 95% confidence intervals (CIs) were calculated.
Results
Among 1,261 patients, 140 (11.1%) demonstrated uACR regression and 1,121 (88.9%) showed progression or no change. Over 24 months, MACE occurred in 8.6% of regressors versus 10.9% of progressors (RR 0.81, 95% CI 0.47-1.41). Patients with regression also exhibited slower decline in eGFR, suggesting parallel renal and cardiovascular protection. While event reduction did not reach statistical significance, directional trends were consistent with GLP- 1-mediated cardiorenal benefit.
Conclusion
In this large real-world Hispanic cohort, regression of microalbuminuria identified patients at lower cardiovascular risk and with better renal outcomes during GLP-1 therapy. This study provides the first evidence that a widely available renal biomarker may serve as an early surrogate of cardiovascular benefit in an underrepresented population, underscoring the need for prospective validation.