Cardionerds: A Cardiology Podcast 432. Journal Club: The TRANSFORM-AF Trial with Dr. Sanjeev Saksena and Dr. Varun Sundaram
Oct 29, 2025
In this discussion, Dr. Varun Sundaram, a renowned cardiologist focused on heart failure, and Dr. Sanjeev Saksena, an expert electrophysiologist, delve into the TRANSFORM-AF Trial's groundbreaking findings. They explore how GLP-1 receptor agonists may reduce atrial fibrillation events in diabetic patients with obesity. The trial revealed a significant 13% decrease in AF-related hospitalizations and emphasized the need for early intervention in managing AF. Additionally, they discuss the potential of GLP-1 benefits beyond weight loss and the crucial role of inflammation in AF and heart failure.
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Obesity Is A Causal AF Risk Factor
- Epidemiology and Mendelian randomization show obesity causally increases AF risk, with risk rising from BMI ~26–27.
- Behavioral weight-loss trials demonstrate efficacy but lack long-term effectiveness without pharmacologic support.
GLP-1s Bridge Efficacy To Real-World Impact
- GLP-1 receptor agonists offer a durable pharmacologic bridge to achieve sustained weight and metabolic control.
- This durability creates an opportunity to translate trial efficacy into real-world cardiovascular benefit.
Treat Metabolic Risk Early In AF Care
- Consider GLP-1 therapy early in AF patients with obesity and diabetes to modify upstream risk factors.
- Use real-world evidence when randomized trials are impractical, while acknowledging limitations.
