TY - JOUR
T1 - GLP-1 Receptor Agonists Among Patients With Overweight or Obesity, Diabetes, and HFpEF on SGLT2 Inhibitors
AU - Patel, Rushin
AU - Wadid, Mark
AU - Makwana, Bhargav
AU - Kumar, Ashish
AU - Khadke, Sumanth
AU - Bhatti, Ammar
AU - Banker, Ahan
AU - Husami, Zaid
AU - Labib, Sherif
AU - Venesy, David
AU - Fonarow, Gregg
AU - Kosiborod, Mikhail
AU - Al-Kindi, Sadeer
AU - Bhatt, Deepak L.
AU - Dani, Sourbha
AU - Nohria, Anju
AU - Butler, Javed
AU - Ganatra, Sarju
N1 - Publisher Copyright:
© 2024 American College of Cardiology Foundation
PY - 2024/11
Y1 - 2024/11
N2 - Background: Although the use of glucagon-like peptide-1 receptor agonist (GLP-1 RA) in patients with obesity and heart failure with preserved ejection fraction (HFpEF) has demonstrated improvement in cardiovascular outcomes, the incremental benefits of GLP-1 RA for patients already on sodium-glucose cotransporter 2 inhibitors (SGLT2is) remain underexplored. Objectives: This study aimed to assess the incremental benefits of GLP-1 RA in patients with type 2 diabetes mellitus, overweight/obesity, and HFpEF receiving SGLT2i therapy. Methods: The authors conducted a retrospective cohort study using the TriNetX research database including patients ≥18 years with type 2 diabetes mellitus, body mass index ≥27 kg/m2, and HFpEF on SGLT2i. Two cohorts were created based on GLP-1 RA prescription. The outcomes were heart failure exacerbation, all-cause emergency department visits/hospitalizations among others over a 12-month period. Results: A total of 7,044 patients remained in each cohort after propensity score matching. There was a significantly lower risk of heart failure exacerbations, all-cause emergency department visits/hospitalizations, new-onset atrial arrhythmias, new-onset acute kidney injury, and pulmonary hypertension in the GLP-1 RA plus SGLT2i cohort compared with the SGLT2i-only cohort. The associated benefits persisted across different body mass indexes and ejection fractions as well as in patients with elevated natriuretic peptide. The risk of diabetic retinopathy was higher in the combination therapy group than with SGLT2i-only use. Conclusions: GLP-1 RA, in addition to SGLT2i, was associated with a significantly lower risk of heart failure hospitalizations in this patient population, suggesting a potential incremental benefit. This highlights the need for prospective studies to confirm the clinical benefits.
AB - Background: Although the use of glucagon-like peptide-1 receptor agonist (GLP-1 RA) in patients with obesity and heart failure with preserved ejection fraction (HFpEF) has demonstrated improvement in cardiovascular outcomes, the incremental benefits of GLP-1 RA for patients already on sodium-glucose cotransporter 2 inhibitors (SGLT2is) remain underexplored. Objectives: This study aimed to assess the incremental benefits of GLP-1 RA in patients with type 2 diabetes mellitus, overweight/obesity, and HFpEF receiving SGLT2i therapy. Methods: The authors conducted a retrospective cohort study using the TriNetX research database including patients ≥18 years with type 2 diabetes mellitus, body mass index ≥27 kg/m2, and HFpEF on SGLT2i. Two cohorts were created based on GLP-1 RA prescription. The outcomes were heart failure exacerbation, all-cause emergency department visits/hospitalizations among others over a 12-month period. Results: A total of 7,044 patients remained in each cohort after propensity score matching. There was a significantly lower risk of heart failure exacerbations, all-cause emergency department visits/hospitalizations, new-onset atrial arrhythmias, new-onset acute kidney injury, and pulmonary hypertension in the GLP-1 RA plus SGLT2i cohort compared with the SGLT2i-only cohort. The associated benefits persisted across different body mass indexes and ejection fractions as well as in patients with elevated natriuretic peptide. The risk of diabetic retinopathy was higher in the combination therapy group than with SGLT2i-only use. Conclusions: GLP-1 RA, in addition to SGLT2i, was associated with a significantly lower risk of heart failure hospitalizations in this patient population, suggesting a potential incremental benefit. This highlights the need for prospective studies to confirm the clinical benefits.
KW - GLP-1 receptor agonists
KW - SGLT2is
KW - heart failure with preserved ejection fraction
KW - obesity
KW - overweight
UR - http://www.scopus.com/inward/record.url?scp=85203798948&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85203798948&partnerID=8YFLogxK
U2 - 10.1016/j.jchf.2024.07.006
DO - 10.1016/j.jchf.2024.07.006
M3 - Article
C2 - 39207323
AN - SCOPUS:85203798948
SN - 2213-1779
VL - 12
SP - 1814
EP - 1826
JO - JACC: Heart Failure
JF - JACC: Heart Failure
IS - 11
ER -