TY - JOUR
T1 - GLP-1-ra and heart failure-related outcomes in patients with and without history of heart failure
T2 - an updated systematic review and meta-analysis
AU - Villaschi, Alessandro
AU - Ferrante, Giuseppe
AU - Cannata, Francesco
AU - Pini, Daniela
AU - Pagnesi, Matteo
AU - Corrada, Elena
AU - Reimers, Bernhard
AU - Mehran, Roxana
AU - Federici, Massimo
AU - Savarese, Gianluigi
AU - Metra, Marco
AU - Condorelli, Gianluigi
AU - Stefanini, Giulio G.
AU - Chiarito, Mauro
N1 - Publisher Copyright:
© The Author(s), under exclusive licence to Springer-Verlag GmbH Germany 2024.
PY - 2024/6
Y1 - 2024/6
N2 - Aims: Glucagon-like peptide-1 receptor agonists (GLP1-ra) have shown to reduce cardiovascular (CV) events in patients with diabetes, including heart failure (HF) hospitalizations. However, whether such benefit consistently occurs in patients with history of HF remains uncertain. We performed a systematic review and meta-analysis to assess the impact of GLP1-ra on CV outcomes in patients with and without HF history. Methods and results: All randomized, placebo-controlled trials evaluating GLP1-ra and reporting CV outcomes stratified by HF history were searched in Pubmed from inception to November 12th, 2023. The primary outcome was HF hospitalizations. Secondary outcomes included CV death, the composite of CV death and hospitalizations for HF, and major adverse cardiovascular events (MACE). Hazard ratio (HR) and 95% confidence interval (CIs) were used as effect estimates and calculated with a random-effects model. 68,653 patients (GLP1-ra = 34,301, placebo = 34,352) from 10 trials were included. GLP1-ra reduced HF hospitalization (no HF: HR = 0.79, 95% CI 0.63–0.98; HF: HR = 1.00, 95% CI 0.82–1.24, pinteraction = 0.12), CV death (no HF: HR = 0.81, 95% CI 0.71–0.92; HF: HR = 0.97, 95% CI 0.81–1.15, pinteraction = 0.11), and the composite 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, pinteraction = 0.010) only in patients without history of HF, despite a significant interaction between HF history and treatment effect was detected only for the latter. MACE were reduced in both subgroups without 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, pinteraction = 0.69). Conclusion: GLP1-ra do not decrease HF-hospitalization risk, despite a potential benefit in patients without history of HF, but are effective in reducing ischemic events irrespective of the presence of HF. PROSPERO-registered (CRD42022371264). Graphical abstract: (Figure presented.)
AB - Aims: Glucagon-like peptide-1 receptor agonists (GLP1-ra) have shown to reduce cardiovascular (CV) events in patients with diabetes, including heart failure (HF) hospitalizations. However, whether such benefit consistently occurs in patients with history of HF remains uncertain. We performed a systematic review and meta-analysis to assess the impact of GLP1-ra on CV outcomes in patients with and without HF history. Methods and results: All randomized, placebo-controlled trials evaluating GLP1-ra and reporting CV outcomes stratified by HF history were searched in Pubmed from inception to November 12th, 2023. The primary outcome was HF hospitalizations. Secondary outcomes included CV death, the composite of CV death and hospitalizations for HF, and major adverse cardiovascular events (MACE). Hazard ratio (HR) and 95% confidence interval (CIs) were used as effect estimates and calculated with a random-effects model. 68,653 patients (GLP1-ra = 34,301, placebo = 34,352) from 10 trials were included. GLP1-ra reduced HF hospitalization (no HF: HR = 0.79, 95% CI 0.63–0.98; HF: HR = 1.00, 95% CI 0.82–1.24, pinteraction = 0.12), CV death (no HF: HR = 0.81, 95% CI 0.71–0.92; HF: HR = 0.97, 95% CI 0.81–1.15, pinteraction = 0.11), and the composite 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, pinteraction = 0.010) only in patients without history of HF, despite a significant interaction between HF history and treatment effect was detected only for the latter. MACE were reduced in both subgroups without 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, pinteraction = 0.69). Conclusion: GLP1-ra do not decrease HF-hospitalization risk, despite a potential benefit in patients without history of HF, but are effective in reducing ischemic events irrespective of the presence of HF. PROSPERO-registered (CRD42022371264). Graphical abstract: (Figure presented.)
KW - Glucagon-like peptide-1 receptor agonists
KW - Heart failure
KW - Major adverse cardiovascular events
UR - http://www.scopus.com/inward/record.url?scp=85182818601&partnerID=8YFLogxK
U2 - 10.1007/s00392-023-02362-6
DO - 10.1007/s00392-023-02362-6
M3 - Article
AN - SCOPUS:85182818601
SN - 1861-0684
VL - 113
SP - 898
EP - 909
JO - Clinical Research in Cardiology
JF - Clinical Research in Cardiology
IS - 6
ER -