GLP-1 Receptor Agonists Among Patients With Overweight or Obesity, Diabetes, and HFpEF on SGLT2 Inhibitors

IF 10.3 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Heart failure Pub Date : 2024-11-01 DOI:10.1016/j.jchf.2024.07.006

Rushin Patel MD , Mark Wadid MD , Bhargav Makwana MD , Ashish Kumar MD , Sumanth Khadke MD , Ammar Bhatti MD , Ahan Banker MBBS , Zaid Husami MD , Sherif Labib MD , David Venesy MD , Gregg Fonarow MD , Mikhail Kosiborod MD , Sadeer Al-Kindi MD , Deepak L. Bhatt MD, MPH, MBA , Sourbha Dani MD , Anju Nohria MD , Javed Butler MD, MPH , Sarju Ganatra MD

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引用次数: 0

Abstract

Background

Although the use of glucagon-like peptide-1 receptor agonist (GLP-1 RA) in patients with obesity and heart failure with preserved ejection fraction (HFpEF) has demonstrated improvement in cardiovascular outcomes, the incremental benefits of GLP-1 RA for patients already on sodium-glucose cotransporter 2 inhibitors (SGLT2is) remain underexplored.

Objectives

This study aimed to assess the incremental benefits of GLP-1 RA in patients with type 2 diabetes mellitus, overweight/obesity, and HFpEF receiving SGLT2i therapy.

Methods

The authors conducted a retrospective cohort study using the TriNetX research database including patients ≥18 years with type 2 diabetes mellitus, body mass index ≥27 kg/m², and HFpEF on SGLT2i. Two cohorts were created based on GLP-1 RA prescription. The outcomes were heart failure exacerbation, all-cause emergency department visits/hospitalizations among others over a 12-month period.

Results

A total of 7,044 patients remained in each cohort after propensity score matching. There was a significantly lower risk of heart failure exacerbations, all-cause emergency department visits/hospitalizations, new-onset atrial arrhythmias, new-onset acute kidney injury, and pulmonary hypertension in the GLP-1 RA plus SGLT2i cohort compared with the SGLT2i-only cohort. The associated benefits persisted across different body mass indexes and ejection fractions as well as in patients with elevated natriuretic peptide. The risk of diabetic retinopathy was higher in the combination therapy group than with SGLT2i-only use.

Conclusions

GLP-1 RA, in addition to SGLT2i, was associated with a significantly lower risk of heart failure hospitalizations in this patient population, suggesting a potential incremental benefit. This highlights the need for prospective studies to confirm the clinical benefits.

查看原文本刊更多论文

服用 SGLT2 抑制剂的超重或肥胖、糖尿病和 HFpEF 患者中的 GLP-1 受体激动剂。

背景：虽然肥胖和射血分数保留型心力衰竭（HFpEF）患者使用胰高血糖素样肽-1受体激动剂（GLP-1 RA）可改善心血管预后，但GLP-1 RA对已使用钠-葡萄糖共转运体2抑制剂（SGLT2is）的患者的增量效益仍未得到充分探讨：本研究旨在评估GLP-1 RA对接受SGLT2i治疗的2型糖尿病、超重/肥胖和HFpEF患者的增量获益：作者利用 TriNetX 研究数据库开展了一项回顾性队列研究，研究对象包括年龄≥18 岁、体重指数≥27 kg/m2 且接受 SGLT2i 治疗的 2 型糖尿病和 HFpEF 患者。根据 GLP-1 RA 处方创建了两个队列。研究结果包括心衰加重、12 个月内全因急诊就诊/住院等：结果：经过倾向得分匹配后，每个队列中共有 7044 名患者。与仅使用SGLT2i的队列相比，GLP-1 RA加SGLT2i队列中心衰加重、全因急诊就诊/住院、新发房性心律失常、新发急性肾损伤和肺动脉高压的风险明显降低。在不同体重指数和射血分数以及钠尿肽升高的患者中，相关益处持续存在。联合治疗组患者发生糖尿病视网膜病变的风险高于仅使用SGLT2i的患者：结论：在这一患者群体中，除 SGLT2i 外，GLP-1 RA 还能显著降低心力衰竭住院风险，这表明它具有潜在的增量效益。这突出表明需要进行前瞻性研究以确认临床益处。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

JACC. Heart failure CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

21.20

自引率

2.30%

发文量

164

期刊介绍： JACC: Heart Failure publishes crucial findings on the pathophysiology, diagnosis, treatment, and care of heart failure patients. The goal is to enhance understanding through timely scientific communication on disease, clinical trials, outcomes, and therapeutic advances. The Journal fosters interdisciplinary connections with neuroscience, pulmonary medicine, nephrology, electrophysiology, and surgery related to heart failure. It also covers articles on pharmacogenetics, biomarkers, and metabolomics.