Glucagon-like peptide-1 (GLP-1) infusion for 48 hours in non-diabetic heart failure patients did not improve LVEF (30% vs 30%; P=0.93) but caused frequent hypoglycemia.
RCT (n=20)
Double-blind
Crossover
Does 48-h GLP-1 infusion improve cardiovascular and metabolic parameters in non-diabetic patients with compensated heart failure?
A 48-hour GLP-1 infusion in non-diabetic patients with compensated heart failure altered metabolic parameters and slightly increased heart rate and diastolic blood pressure, but did not improve LVEF or cardiac index and caused frequent hypoglycemia.
Absolute Event Rate: 30% vs 30%
p-value: p=0.93
The incretin hormone glucagon-like peptide-1 (GLP-1) and its analogs are currently emerging as antidiabetic medications. GLP-1 improves left ventricular ejection fraction (LVEF) in dogs with heart failure (HF) and in patients with acute myocardial infarction. We studied metabolic and cardiovascular effects of 48-h GLP-1 infusions in patients with congestive HF. In a randomized, double-blind crossover design, 20 patients without diabetes and with HF with ischemic heart disease, EF of 30 +/- 2%, New York Heart Association II and III (n = 14 and 6) received 48-h GLP-1 (0.7 pmol.kg(-1).min(-1)) and placebo infusion. At 0 and 48 h, LVEF, diastolic function, tissue Doppler regional myocardial function, exercise testing, noninvasive cardiac output, and brain natriuretic peptide (BNP) were measured. Blood pressure, heart rate, and metabolic parameters were recorded. Fifteen patients completed the protocol. GLP-1 increased insulin (90 +/- 17 pmol/l vs. 69 +/- 12 pmol/l; P = 0.025) and lowered glucose levels (5.2 +/- 0.1 mmol/l vs. 5.6 +/- 0.1 mmol/l; P < 0.01). Heart rate (67 +/- 2 beats/min vs. 65 +/- 2 beats/min; P = 0.016) and diastolic blood pressure (71 +/- 2 mmHg vs. 68 +/- 2 mmHg; P = 0.008) increased during GLP-1 treatment. Cardiac index (1.5 +/- 0.1 l.min(-1).m(-2) vs. 1.7 +/- 0.2 l.min(-1).m(-2); P = 0.54) and LVEF (30 +/- 2% vs. 30 +/- 2%; P = 0.93), tissue Doppler indexes, body weight, and BNP remained unchanged. Hypoglycemic events related to GLP-1 treatment were observed in eight patients. GLP-1 infusion increased circulating insulin levels and reduced plasma glucose concentration but had no major cardiovascular effects in patients without diabetes but with compensated HF. The impact of minor increases in heart rate and diastolic blood pressure during GLP-1 infusion requires further studies. Hypoglycemia was frequent and calls for caution in patients without diabetes but with HF.
Halbirk et al. (Sat,) conducted a rct in Congestive heart failure (n=20). Glucagon-like peptide-1 (GLP-1) vs. Placebo was evaluated on Left ventricular ejection fraction (LVEF) (p=0.93). Glucagon-like peptide-1 (GLP-1) infusion for 48 hours in non-diabetic heart failure patients did not improve LVEF (30% vs 30%; P=0.93) but caused frequent hypoglycemia.