Effect of glucagon-like peptide-1 receptor agonists on heart failure outcomes and cardiovascular death across varying cardiovascular-kidney-metabolic comorbidity
A meta-analysis of 15 trials in nearly 88,000 patients found GLP-1 receptor agonists reduced heart-failure hospitalization and cardiovascular death across heart failure, diabetes, and obesity, with a possible exception in heart failure with reduced ejection fraction.
Study design
The authors queried online databases through November 2024 for primary and secondary analyses of GLP-1 receptor agonist outcome trials in patients with heart failure, type 2 diabetes, chronic kidney disease, obesity, or combinations of these conditions. Fifteen trials totalling 87,549 patients were analysed with random-effects models for a composite of heart-failure hospitalization or cardiovascular death and its components.
Key findings
Versus placebo, GLP-1 receptor agonists reduced the composite of heart-failure hospitalization or cardiovascular death in heart failure (HR 0.81), type 2 diabetes (HR 0.85), and obesity (HR 0.70), with a non-significant reduction in chronic kidney disease (HR 0.79). Cardiovascular death fell in heart failure, diabetes, and obesity. In the HFrEF subgroup, there was a non-significant increase in heart-failure hospitalization (HR 1.17) alongside a significant reduction in cardiovascular death (HR 0.67).
Safety
GLP-1 receptor agonists were not associated with an increased risk of serious adverse events (RR 0.94, 95% CI 0.89-1.00).
Clinical implications
The data support GLP-1 receptor agonists for reducing heart-failure events and cardiovascular death across most cardiovascular-kidney-metabolic phenotypes, but the divergent HFrEF signal argues for dedicated trials before routine use in established HFrEF.
Category
Research
Source
European Journal of Heart Failure
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