The Short and Sweet on Sodium-Glucose Cotransporter Inhibitors and Glucagon-like Peptide-1 Receptor Agonists in Heart Failure.

Abstract

Heart failure (HF) affects 6 million people in the US, and type 2 diabetes (T2D) is a significant risk factor for HF. Since 2008, regulatory agencies have required cardiovascular safety trials for new T2D therapies, and these have consistently demonstrated the cardiovascular benefits of glucose-lowering drugs. Sodium-glucose cotransporter inhibitors (SGLTi) and glucagon-like peptide-1 (GLP-1) receptor agonists (RAs)/glucose-dependent insulinotropic polypeptide (GIP) reduce major adverse cardiovascular events and deaths, regardless of diabetes status, and improve cardiorespiratory fitness. SGLTis, such as dapagliflozin and empagliflozin, benefit patients with reduced and preserved ejection fraction, significantly reducing HF hospitalizations and cardiovascular deaths. The DAPA-HF and EMPEROR-Reduced trials showed dapagliflozin and empagliflozin reduce worsening HF or cardiovascular death by 26%. GLP-1 RAs such as semaglutide and the dual GLP-1/GIP receptor agonist tirzepatide improve clinical symptoms, HF hospitalizations, major adverse cardiovascular events, exercise capacity, and quality of life in patients with HF. However, these agents have side effects that must be considered. This review examines the role and efficacy of SGLTis and GLP-1 RAs in established HF.