The following is a summary of “GLP-1-ra and heart failure-related outcomes in patients with and without history of heart failure: an updated systematic review and meta-analysis,” published in the January 2024 issue of Cardiology by Villaschi et al.

While Glucagon-like peptide-1 receptor agonists (GLP1-ra) have demonstrated efficacy in reducing cardiovascular (CV) events, including heart failure (HF) hospitalizations, their consistent benefits in patients with a history of HF in the context of diabetes remain uncertain.

Researchers conducted a retrospective study to evaluate the outcomes of GLP-1 receptor agonists in patients with type 2 diabetes, stratified by baseline HF history.

They systematically searched Pubmed for all randomized, placebo-controlled trials assessing GLP1-ra and reporting CV outcomes stratified by HF history, covering the period from inception to November 12th, 2023. The primary outcome examined was HF hospitalizations, with secondary outcomes including CV death, the composite of CV death and hospitalizations for HF, and major adverse CV events (MACE). HR and 95% CI represented effect estimates, calculated using a random-effects model.

The result showed that a total of 68,653 patients (GLP1-ra = 34,301, placebo = 34,352) drawn from 10 trials were incorporated. GLP1-ra exhibited a reduction in HF hospitalization solely in patients without a history of HF (no HF: HR = 0.79, 95% CI 0.63–0.98; HF: HR = 1.00, 95% CI 0.82–1.24, P_interaction=0.12), along with decreases in CV death (no HF: HR = 0.81, 95% CI 0.71–0.92; HF: HR = 0.97, 95% CI 0.81–1.15, P_interaction= 0.11), and the combined endpoint of HF hospitalizations and CV death (no HF: HR = 0.80, 95% CI 0.72–0.89; HF: HR = 1.00, 95% CI 0.88–1.15, P_interaction=0.010). Notably, a significant interaction between HF history and treatment effect was observed only for the latter. MACE demonstrated reduction in both subgroups without a significant interaction between HF history and treatment effect (no HF: HR = 0.86, 95% CI 0.78–0.96; HF: HR = 0.83, 95% CI 0.72–0.95, P_interaction=0.69).

Investigators concluded that GLP1-ras offered no clear benefit for heart failure hospitalizations, and proved effective in reducing ischemic events across all patients.

Source: link.springer.com/article/10.1007/s00392-023-02362-6