ESC heart failureMar 26, 2026

Glucagon-like peptide-1 drugs and their role in preventing heart failure in people with type 2 diabetes or obesity

GLP-1 Therapies Weekly Brief ↗PubMed ↗DOI ↗OA ↗

Updated Mar 27, 2026

Abstract

GLP-1 receptor agonists reduced heart failure events by 12% in patients with type 2 diabetes and/or obesity.

In 12 placebo-controlled trials with 95,023 patients, GLP-1 receptor agonists were associated with a relative risk reduction of 12% for heart failure events.
The absolute risk reduction was 0.42%, suggesting a limited benefit in preventing heart failure.
The number needed to treat to prevent one heart failure event was 238.
For patients without baseline heart failure, the relative risk reduction increased to 19%, with an absolute risk reduction of 0.60%.
In this subgroup, the number needed to treat decreased to 167.
Semaglutide specifically showed a 16% reduction in heart failure events overall and a 31% reduction in patients without baseline heart failure.

Simplified

BACKGROUND AND AIMS: Heart failure (HF) is a common sequela of diabetes and obesity. Glucagon-like peptide-1 (GLP-1) receptor agonists may prevent HF events. This meta-analysis estimates absolute risk reduction (ARR) and number needed to treat (NNT) for GLP-1 receptor agonists to prevent one HF event in patients with type 2 diabetes and/or obesity, including in those without baseline HF.

METHODS: The Medline, Embase, and Cochrane Central databases were searched to 04 April 2025 for placebo-controlled randomised controlled trials (RCTs) of GLP-1 receptor agonists in a type 2 diabetes and/or obesity indication with a prespecified heart failure event endpoint. Random effects meta-analysis using the Mantel-Haenszel Method was performed to synthesise risk ratios (RR), ARRs, and NNTs with 95% confidence intervals (CI).

RESULTS: Twelve placebo-controlled RCTs involving 95 023 patients were included. GLP-1 receptor agonists reduced HF events by 12% (RR 0.88, 95% CI 0.82-0.95; ARR 0.42%, 95% CI 0.17%-0.62%; NNT 238, 95% CI 161-588), and, in those without baseline HF, by 19% (RR 0.81, 95% CI 0.72-0.90; ARR 0.60%, 95% CI 0.32%-0.89%; NNT 167, 95% CI 113-313). Semaglutide reduced the risk of HF events by 16% (RR 0.84, 95% CI 0.74-0.95; ARR 0.62%, 95% CI 0.19%-1.00%; NNT 161, 95% CI 100-526), and by 31% in those without baseline HF (RR 0.69, 95% CI 0.55-0.88; ARR 1.25%, 95% CI 0.48%-1.82%; NNT 80, 95% CI 55-208).

CONCLUSIONS: GLP-1 receptor agonists have limited absolute benefit for preventing HF events in patients with type 2 diabetes and/or obesity, including in those without baseline HF.

SYSTEMATIC REVIEW REGISTRATION: PROSPERO: CRD420251074882.

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Glucagon-like peptide-1 drugs and their role in preventing heart failure in people with type 2 diabetes or obesity

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