Glucagon-like peptide-1 receptor agonists (GLP-1 RA) as adjunct to standard treatment in diabetic patients with chronic heart failure: a systematic review & meta-analysis

Abstract Background Glucagon-like peptide 1 receptor agonists' (GLP-1 RA) effect on secondary prevention of MACE has yet to be investigated in diabetic patients with chronic heart failure. Purpose We aimed to determine the effectiveness of GLP-1 RA as adjunct to standard treatment among diabetic patients with chronic heart failure (LVEF 50%), in preventing major adverse cardiovascular events (MACE): cardiovascular death, nonfatal myocardial infarction, and nonfatal stroke. Methods We searched for eligible trials reporting MACE, all-cause mortality, hospitalization for heart failure, improvement of LVEF and functional capacity (6-minute walk test). Fixed-effects model was used to estimate overall risk ratio for MACE, all-cause mortality and hospitalization for heart failure, while mean difference was used for estimation of improvement of LVEF and functional capacity. Review Manager 5.3 was used for analysis. Results Ten studies (56,597 patients) were included: LIVE, FIGHT, ZHANG, LEADER, ELIXA, SUSTAIN-6, PIONEER-6, EXSCEL, HARMONY, and REWIND. Addition of GLP-1 RA and Liraglutide did not significantly reduce MACE (RR 0.90, CI 95% 0.78–1.03), (RR 0.91, CI 95% 0.69–1.20). Moreover, Liraglutide did not significantly reduce cardiovascular death (RR 0.99, CI 95% 0.14–7.15). No significant effect on LVEF and functional capacity was demonstrated in this study. Conclusion GLP-1 RA use in diabetic patients with chronic heart failure may have modest effect on functional capacity but did not significantly affect MACE, all-cause mortality, and LVEF. Funding Acknowledgement Type of funding source: Private hospital(s). Main funding source(s): Department of Internal Medicine, Manila Doctors Hospital