Glucagon-Like Peptide-1 Receptor Agonists Across the Spectrum of Heart Failure

Area of Science:

• Cardiology
• Endocrinology
• Pharmacology

Background:

• Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are established treatments for type 2 diabetes (T2D) and obesity, improving glycemic control and cardiovascular outcomes.
• The efficacy and safety of GLP-1 RAs may be influenced by the presence and type of heart failure (HF).

Approach:

• This review synthesizes current evidence on GLP-1 RA use in patients with varying cardiovascular risk, with a specific emphasis on heart failure.
• The approach challenges existing treatment paradigms and advocates for proactive heart failure screening prior to GLP-1 RA initiation.

Key Points:

• Pre-treatment screening for HF, including clinical assessment, echocardiography, and natriuretic peptides, is recommended before starting GLP-1 RAs.
• In T2D patients without HF, GLP-1 RAs reduce atherosclerotic events and may lower HF hospitalizations.
• In HF with preserved ejection fraction (HFpEF), GLP-1 RAs may offer benefits for atherosclerotic events but do not reduce HF hospitalizations; individualized consideration is advised.
• In HF with reduced ejection fraction (HFrEF), GLP-1 RA use requires caution due to potential risks of worsening HF and arrhythmias, pending further data.

Conclusions:

• GLP-1 RA treatment decisions should be stratified based on HF status and type.
• Active HF screening is essential to optimize GLP-1 RA therapy and patient outcomes.
• Further research is needed to clarify the risk-benefit profile of GLP-1 RAs in patients with HFrEF.