Abstract 13450: Clinical Outcomes With GLP-1 Receptor Agonists in Patients With Heart Failure: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Abstract

Background: Glucagon-like peptide 1 receptor agonists (GLP-1 RAs) reduce the risk of major adverse cardiovascular events (MACE) in patients with type 2 diabetes mellitus (T2DM). However, there remains uncertainty about the efficiency of GLP-1 RAs in patients with heart failure (HF). Methods: Randomized controlled trials (RCTs) that reported the effect of GLP-1 RAs on prognosis in patients with HF were identified by searching databases. Results: There were nine RCTs involving 8,920 patients with HF included. GLP-1 RAs significantly reduced the risk of MACE compared with placebo (HR [hazard ratio]: 0.87, 95% CI [confidence interval] 0.77-0.98) in patients with HF and T2DM. The benefit was not observed in all-cause death (HR: 0.99, 95% CI 0.84-1.15), hospitalization for HF (HR: 1.04, 95% CI 0.89-1.22), cardiovascular death (HR: 0.95, 95% CI 0.79-1.16), myocardial infarction (HR: 0.88, 95% CI 0.71-1.08), stroke (HR: 1.03, 95% CI 0.75-1.43) and death or hospitalization for HF (HR: 1.07, 95% CI 0.78-1.46). GLP-1 RAs did not improve the change in LVEF (MD [mean difference]: -0.86, p=0.12, LVEDV (MD: 3.54, p=0.11), LVESV (MD: 2.78, p=0.07) or NT-proBNP (MD: -140.36, p=0.08). However, GLP-1 RAs significantly increased the change in the 6-MWT (MD: 19.74, p=0.002). In the subgroup analyses, human GLP-1 RAs, but not nonhuman GLP-1 RAs, reduced the risk of MACE (p interaction=0.11). Grading of Recommendations Assessment, Development and Evaluation (GRADE) showed moderate certainty for MACE, all-cause death and hospitalization for HF. Trail Sequential Analysis (TSA) revealed that there may be a high possibility of false positive results for MACE. Conclusion: Compared with placebo, GLP-1 RAs may reduce the risk of MACE in patients with HF and T2DM, with a more significant efficiency of human GLP-1 RAs.