Effects of glucagon-like peptide-1 receptor agonists on patients with heart failure: a meta-analysis of randomized controlled trials

Aims Glucagon-like peptide-1 receptor agonists (GLP-1RAs) reduce the risk of major adverse cardiovascular events (MACE) and heart failure in patients with type 2 diabetes mellitus (T2DM). However, these outcomes are not similarly demonstrated in those with prior heart failure in subgroup analyses of several randomized controlled trials (RCTs). We evaluated the effect of GLP-1RAs on MACE and heart failure admissions for T2DM patients with a previous history of heart failure. Methods We searched PubMed and EMBASE through March 2022 to identify RCTs examining the effects of GLP-1RAs compared with placebo on MACE and heart failure admission in T2DM patients with a history of heart failure. MACE were mainly defined as a composite of cardiovascular death, nonfatal myocardial infarction, and nonfatal stroke. We performed a meta-analysis with a random-effects model. Results Our analysis included subgroup analyses of 7 RCTs enrolling a total of 8,965 patients with T2DM and heart failure. Pooled analysis demonstrated a significantly decreased MACE (hazard ratio, 0.88; 95% confidence interval, 0.78–0.99; P = 0.039; I2 = 18.1%) in the GLP-1RAs group. In contrast, the rate of heart failure admission was not significantly different between the two groups (hazard ratio, 1.03; 95% confidence interval, 0.91–1.16; P = 0.67; I2 = 0.0%). Conclusion GLP-1RAs significantly reduced MACE in T2DM patients with prior heart failure compared with the placebo group but did not affect the risk of heart failure admission.