Comparative Outcomes of Glucagon‐Like Peptide‐1 Receptor Agonists to Dipeptidyl Peptidase 4 Inhibitors in Patients With Heart Failure and Type 2 Diabetes

🥉 Top 5% JournalFeb 8, 2025Journal of the American Heart Association

Comparing effects of two diabetes drugs on patients with heart failure and type 2 diabetes

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Abstract

Among 1,005,097 patients with heart failure and type 2 diabetes, 5.9% of those on GLP1-RA experienced all-cause death within 12 months, compared to 8.5% on DPP-4i.

GLP1-RA was associated with a lower incidence of all-cause death compared to DPP-4i (odds ratio 0.67).
The incidence of hospitalization was also lower in the GLP1-RA group than in the DPP-4i group (odds ratio 0.78).
Both outcomes were assessed over a 12-month period following treatment initiation.
The study included matched groups of 36,557 participants for each treatment type.

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BACKGROUND: Clinical trials showed that glucagon-like peptide-1 receptor agonist (GLP1-RA) significantly improved the control of diabetes and reduced body weight compared with dipeptidyl peptidase 4 inhibitor (DPP-4i). However, it is unclear whether GLP1-RA is effective compared with DPP-4i in patients with heart failure (HF) with type 2 diabetes (T2D). The purpose of this study was to evaluate the risk of GLP1-RA compared with DPP-4i in all-cause death and hospitalization in patients with HF and T2D.

METHODS: This multicenter retrospective observational study using TriNetX, a global health care data and analytics platform, included patients with HF and T2D who had received GLP1-RA or DPP-4i from January 1, 2018, to December 31, 2022. Primary outcome was 12-month incidence of all-cause death. Secondary outcome was hospitalization. We used odds ratios (ORs) and 95% CIs to evaluate outcome measures.

RESULTS: Among 1 005 097 patients with HF and T2D, 57 965 initiated GLP1-RA and 77 098 initiated DPP-4i. After propensity score matching, the number of participants in both the GLP1-RA group and the DPP-4i group was 36 557. The proportion of 12-month incidence of all-cause death was lower in the GLP1-RA group than in the DPP-4i group (5.9% [2140/36 557] versus 8.5% [3103/36 557]; OR, 0.67 [95% CI, 0.63-0.71]).The proportion of 12-month incidence of hospitalization was also lower in the GLP1-RA group than in the DPP-4i group (42.3% [15 455/36 557] versus 48.5% [17 733/36 557]; OR, 0.78 [95% CI, 0.76-0.80]).

CONCLUSIONS: Use of GLP1-RA for patients with HF and T2D was associated with reduced 12-month incidence of all-cause death and hospitalization compared with DPP-4i.

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