International journal of cardiologyOct 11, 2024

Glucagon-like peptide-1 receptor agonists improve health in people with type 2 diabetes, both with and without heart failure

GLP-1 Therapies Weekly Brief ↗PubMed ↗DOI ↗

Updated Jan 20, 2026

Abstract

GLP1 receptor agonists (GLP1Ras) are associated with lower mortality rates in patients with type 2 diabetes (T2DM).

In individuals with T2DM without heart failure (HF), GLP1Ras were linked to a composite outcome of all-cause mortality and new HF diagnosis occurring in 10.5% compared to 11.8% for sitagliptin.
The use of GLP1Ras resulted in a hazard ratio (HR) of 0.82 for the composite endpoint, indicating a reduced risk.
Mortality among T2DM patients without HF was significantly lower with GLP1Ras (HR 0.66) compared to sitagliptin.
In T2DM patients with HF, those using GLP1Ras had a mortality rate of 17.6%, compared to 22.8% for those on sitagliptin, with an HR of 0.70.
Lower mortality rates with GLP1Ras were consistent across various subgroups analyzed.

Simplified

BACKGROUND: The effectiveness of glucagon-like peptide-1 receptor agonists (GLP1Ras) for prevention of heart failure (HF) in patients with type 2 diabetes (T2DM) without HF and for risk of death in patients with T2DM with HF has not been fully elucidated in routine clinical practice.

METHODS: Using the real-world global electronic medical record TriNetX database, individuals with T2DM and with or without HF who initiated either GLP1Ras or sitagliptin from 2017 to 2020 were retrospectively analyzed. In individuals with T2DM without HF, the primary outcome was a composite of all-cause mortality and a new diagnosis of HF within three years. In individuals with T2DM with HF, the primary outcome was all-cause mortality within three years. Propensity-score (PS) matching was used to adjust for over 100 baseline characteristics.

RESULTS: A total of 65,598 individuals with T2DM without HF starting a GLP1Ras were PS matched with 65,598 starting sitagliptin. GLP1Ras were associated with a lower incidence of the composite endpoint (10.5 % versus 11.8 %, hazard ratio [HR] 0.82, [0.80-0.85], p < 0.001), mortality (HR 0.66 [0.63-0.69]) and new diagnosis of HF (HR 0.92 [0.88-0.96]). There were 6002 individuals in each group matched for T2DM and HF. Mortality was lower in the GLP1Ras group (17.6 % versus 22.8 %, HR 0.70 [0.65-0.76], p < 0.001). Results were consistent across subgroups.

CONCLUSIONS: In this global real-world data analysis, GLP1Ra use was associated with a lower risk of death and HF in individuals with T2DM without HF, and lower risk of death in those with HF.

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Declaration of competing interest Yu Horiuchi received honoraria from TriNetX, Nippon Boehringer Ingelheim, Ono Pharmaceutical Company, AstraZeneca, Kyowa Kirin, Sanofi and Eli Lilly Japan. Nicholas Wettersten received grants from Department of Veterans Affairs National Institutes of Health, consulting fees from Guidepoint and honoraria from San Diego Heart Failure Symposium. Masahiko Asami received honoraria from Astellas, Daiichi Sankyo, AstraZeneca and Kyowa Kirin. Kazuyuki Yahagi received honoraria from Daiichi Sankyo and Nippon Boehringer Ingelheim. Hitomi Yuzawa received honoraria from Daiichi Sankyo. Kota Komiyama received honoraria from Astellas, Daiichi Sankyo, Ono Pharmaceutical and Kowa. Jun Tanaka received honoraria from Eli Lilly Japan, Novo Nordisk and Daiichi Sankyo. Jiro Aoki received honoraria from Daiichi Sankyo, Ono Pharmaceutical and Kowa, and has stock of Eli Lilly and Novo Nordisk. Kengo Tanabe received honoraria from Eli Lilly Japan, Novo Nordisk, Daiichi Sankyo, Ono Pharmaceutical, Industry, AstraZeneca and Kowa.

PubMed

Glucagon-like peptide-1 receptor agonists improve health in people with type 2 diabetes, both with and without heart failure

Abstract

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