What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: Type 2 diabetes with and without chronic heart failure (n=54092). Intervention: Glucagon-like peptide 1 receptor agonists (GLP1-RA) vs. Placebo. Primary outcome: Composite of HF hospitalization or cardiovascular death (HR 0.96 (with HF); HR 0.84 (without HF), 95% CI 0.84-1.08 (with HF); 0.76-0.92 (without HF)).

February 1, 2023Open Access

Glucagon‐like peptide 1 receptor agonists in patients with type 2 diabetes with and without chronic heart failure: A meta‐analysis of randomized placebo‐controlled outcome trials

Key Result

GLP1-RA did not reduce HF hospitalization or CV death in T2D patients with HF history (HR 0.96; 95% CI 0.84-1.08), but reduced this outcome in those without HF (HR 0.84; 95% CI 0.76-0.92).

Study Design

Type

Meta-Analysis (n=54,092)

Structured PICO

Does GLP1-RA reduce the composite of HF hospitalization or cardiovascular death in stable ambulatory patients with type 2 diabetes with and without heart failure?

Population

54,092 stable ambulatory patients with type 2 diabetes (T2D) from 7 randomized controlled trials, including 8,460 (16%) with a history of heart failure.

Intervention

Glucagon-like peptide 1 receptor agonists (GLP1-RA)

Comparator

Placebo

Outcome

Composite of HF hospitalization or cardiovascular deathcomposite

GLP1-RAs reduce atherosclerotic events regardless of HF history, but only reduce HF hospitalizations and mortality in T2D patients without a prior history of heart failure.

Main Result

Effect estimate: HR 0.96 (with HF); HR 0.84 (without HF) (95% CI 0.84-1.08 (with HF); 0.76-0.92 (without HF))

Abstract

AIM: Glucagon-like peptide 1 receptor agonists (GLP1-RA) reduce atherosclerotic events in patients with type 2 diabetes (T2D) and a high cardiovascular risk. The effect of GLP1-RA to reduce heart failure (HF) has been inconsistent across T2D trials, and individual trials were underpowered to assess the effect of GLP1-RA according to HF history. In this meta-analysis we aim to assess the effect of GLP1-RA in patients with and without HF history in stable ambulatory patients with T2D. METHODS: Random-effects meta-analysis of placebo-controlled trials. The hazard ratio (HR) and 95% confidence intervals (95% CI) were extracted from the treatment effect estimates of HF subgroup analyses reported in each individual study. The primary outcome was a composite of HF hospitalization or cardiovascular death. RESULTS: In total, 54 092 patients with T2D from seven randomized controlled trials were included, of whom 8460 (16%) had HF history. Compared with placebo, GLP1-RA did not reduce the composite of HF hospitalization or cardiovascular death in patients with HF history: HR 0.96, 95% CI: 0.84-1.08, but reduced this outcome in patients without HF history: HR 0.84, 95% CI: 0.76-0.92. GLP1-RA did not reduce all-cause death in patients with HF history: HR 0.98, 95% CI: 0.86-1.11, but reduced mortality in patients without HF history: HR 0.85, 95% CI: 0.79-0.92. GLP1-RA reduced atherosclerotic events regardless of HF history: HR 0.85, 95% CI: 0.75-0.97 with HF, and HR 0.88, 95% CI: 0.83-0.93 without HF. CONCLUSIONS: Treatment with GLP1-RA did not reduce HF hospitalizations and mortality in patients with concomitant T2D and HF, but may prevent new-onset HF and mortality in patients with T2D without HF. The reduction of atherosclerotic events with GLP1-RA was not influenced by HF history status.