Glucagon-Like Peptide 1 Receptor Agonist Is Associated With Improved Survival in Overweight Heart Failure Patients

Mar 15, 2025JACC. Heart failure

Glucagon-like peptide 1 receptor agonist linked to better survival in overweight heart failure patients

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Abstract

Among 34,247 patients with heart failure, 808 patients were treated with GLP-1 receptor agonists.

GLP-1 receptor agonist treatment is associated with a 25% reduction in all-cause mortality within two years.
A 48% reduction in cardiovascular mortality was observed in patients treated with GLP-1 receptor agonists.
In a matched cohort, GLP-1 receptor agonists showed no significant link to all-cause mortality but were associated with a 47% reduction in cardiovascular mortality.
The reduction in cardiovascular death was more significant in patients with a body mass index greater than 30 kg/m².
Patients with a lower ejection fraction (≤40%) experienced a greater reduction in cardiovascular mortality compared to those with a higher ejection fraction.

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BACKGROUND: Glucagon-like peptide 1 receptor agonists (GLP-1RAs) have shown improved symptomatic relieving and functional capacity in patients with heart failure (HF) with preserved ejection fraction and obesity.

OBJECTIVES: The purpose of this study was to evaluate the effect of GLP-1RA on outcome in patients with HF.

METHODS: A retrospective analysis was performed based on the Swedish HF Registry since 2007 among patients with a body mass index (BMI) >25 kg/mto assess whether GLP-1RA treatment was associated with reduced mortality in patients with HF. 2

RESULTS: In the overall cohort, 34,247 patients were not treated with GLP-1RA, and 808 patients were. In patients treated with GLP-1RA, 96.3% had diabetes mellitus. Treatment with GLP-1RA showed a statistically significant association with reduced all-cause (adjusted HR [aHR]: 0.75 [95% CI: 0.60-0.94]; P = 0.013) and cardiovascular (CV) mortality (aHR: 0.52 [95% CI: 0.35-0.77]; P = 0.0010) compared with those not receiving GLP-1RA within 2 years after index registration. In a 1:1 propensity score matched cohort, there was no significant association between GLP-1RA and all-cause mortality (aHR: 0.79 [95% CI: 0.59-1.06]; P = 0.11), but there was with CV mortality (aHR: 0.53 [95% CI: 0.32-0.87]; P = 0.012). GLP-1RA-associated risk reduction in CV death was more pronounced in patients with a BMI >30 kg/mand appears to be greater in individuals with an ejection fraction ≤40% compared with >40%. 2

CONCLUSIONS: This nationwide real-world study shows that patients with HF who received GLP-1RA have a significant reduction in CV mortality, which is particularly pronounced in overweight and obese patients with reduced ejection fraction.

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Glucagon-Like Peptide 1 Receptor Agonist Is Associated With Improved Survival in Overweight Heart Failure Patients

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