The Safety and Efficacy of GLP-1 Receptor Agonists in Heart Failure Patients: A Systematic Review and Meta-Analysis

Merza, Nooraldin; Akram, Moeez; Mengal, Aqsa; Rashid, Ahmed Mustafa; Mahboob, Anber; Faryad, Mawwra; Fatima, Zairah; Ahmed, Muhammad; Ansari, Saad Ali

doi:10.1016/j.cpcardiol.2023.101602

Cited by 13 publications

(4 citation statements)

References 23 publications

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“…A further recent meta-analysis study, performed to verify whether the use of GLP-1 RAs in patients with HF with or without type 2 diabetes could improve morbidity and mortality compared to placebo treatment, also demonstrated that the GLP-1 RAs did not lead to an improvement in major adverse cardiovascular events, including cardiovascular mortality, or a reduction in hospitalizations for HF. Furthermore, they did not determine an improvement in EF and in the six-minute walking test [72].…”

Section: Glucagon-like Peptide-1 Receptor Agonistsmentioning

confidence: 91%

The Negative Impact of Insulin Resistance/Hyperinsulinemia on Chronic Heart Failure and the Potential Benefits of Its Screening and Treatment

Fazio,

Mercurio,

Affuso

et al. 2023

Biomedicines

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This opinion article highlights the potential alterations caused by insulin resistance and hyperinsulinemia on the cardiovascular system and their negative impact on heart failure (HF), and describes the potential benefits of an early screening with consequent prompt treatment. HF is the final event of several different cardiovascular diseases. Its incidence has been increasing over the last decades because of increased survival from ischemic heart disease thanks to improvements in its treatment (including myocardial revascularization interventions) and the increase in life span. In particular, incidence of HF with preserved ejection fraction (HFpEF) is significantly increasing, and patients with HFpEF often are also affected by diabetes mellitus and insulin resistance (IR), with a prevalence > 45%. Concentric left ventricular (LV) remodeling and diastolic dysfunction are the main structural abnormalities that characterize HFpEF. It is well documented in the literature that IR with chronic hyperinsulinemia, besides causing type 2 diabetes mellitus, can cause numerous cardiovascular alterations, including endothelial dysfunction and increased wall thicknesses of the left ventricle with concentric remodeling and diastolic dysfunction. Therefore, it is conceivable that IR might play a major role in the pathophysiology and the progressive worsening of HF. To date, several substances have been shown to reduce IR/hyperinsulinemia and have beneficial clinical effects in patients with HF, including SGLT2 inhibitors, metformin, and berberine. For this reason, an early screening of IR could be advisable in subjects at risk and in patients with heart failure, to promptly intervene with appropriate therapy. Future studies aimed at comparing the efficacy of the substances used both alone and in association are needed.

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Section: Glucagon-like Peptide-1 Receptor Agonistsmentioning

confidence: 91%

The Negative Impact of Insulin Resistance/Hyperinsulinemia on Chronic Heart Failure and the Potential Benefits of Its Screening and Treatment

Fazio,

Mercurio,

Affuso

et al. 2023

Biomedicines

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“…Another recent meta-analysis carried out on 54,092 pts from 7 randomized controlled trials on the use of GLP-1 Ras in subjects with type 2 diabetes, of whom 16% also had a history of HF, demonstrated that these drugs appear to protect the diabetic population from the development of HF, but, in subjects with pre-existing HF, they do not reduce the onset of episodes of HF exacerbation with consequent hospitalization, nor mortality ( 73 ). A further recent meta-analysis carried out to verify whether treatment with GLP-1 Ras in subjects with HF, with or without type 2 diabetes, could lead to a reduction in morbidity and mortality compared to placebo, also demonstrated that this therapy did not reduce the number of major adverse cardiovascular events, including cardiovascular mortality or reduction in hospital admissions for HF, and did not lead to an improvement in HF or six-minute walking test ( 74 ).…”

Section: Tratment Of Ir/hyperinsmentioning

confidence: 99%

Insulin resistance/hyperinsulinemia: an important cardiovascular risk factor that has long been underestimated

Fazio,

Mercurio,

Tibullo

et al. 2024

Front. Cardiovasc. Med.

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Cardiovascular mortality is still excessively high, despite the considerable progress made in the prevention and treatment of cardiovascular diseases. Although many cardiovascular risk factors (such as arterial hypertension, hypercholesterolemia, diabetes, etc.), identified in the general population, are being promptly treated, to date little consideration is given to a cardiovascular risk factor which we believe has largely demonstrated in the scientific literature of the last three decades that, if neglected, can produce a series of relevant negative effects on the cardiovascular system: insulin resistance (IR)/hyperinsulinemia (Hyperins). This risk factor is still not sufficently sought in the general population and, consequently, is not treated promptly, as it should be, to avoid its negative impact on the cardiovascular system. IR's prevalence is constantly growing worldwide, and it is estimated to have reached a prevalence of 51% of the general population in developed and developing countries, and Hyperins is a constant and strong feature of IR. This article aims to stimulate the scientific community towards IR/Hyperins as relevant cardiovascular risk factor, since it is still neglected. The scientific literature analyzed and used to for this article was found on PubMed, Scopus, Science Direct, etc, using the following keywords: insulin, insulin signaling, insulin resistance, hyperinsulinemia, cardiovascular risk factors, cardiovascular system, cardiovascular diseases. We selected studies that explored the association between IR/Hyperins and the cardiovascular system, and those that discussed the possibilities of screening and treatment of IR/Hyperins.

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“…However, Merza et al noted that compared with a placebo, the controversial medicine GLP-1 RAs did not increase the risk of experiencing MACEs ( 80 ). However, in his study, Merza et al assembled only 9 randomized controlled trials (RCTs) containing only 871 participants, which is small for a meta-analysis.…”

Section: Introductionmentioning

confidence: 99%

Value of the triglyceride–glucose index and related parameters in heart failure patients

Fang,

Shen,

Lyu

2024

Front. Cardiovasc. Med.

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The triglyceride–glucose (TyG) index, proven to be a crucial insulin resistance biomarker (better than the Homeostasis Model Assessment for Insulin Resistance), is simple and non-invasive. Recently, indisputable evidence has shown that the TyG index is strongly associated with cardiovascular disease [CVD, including atherosclerosis, heart failure (HF), and hypertension] prognosis and mortality. Nevertheless, the value of the TyG index in HF patients treated with sodium–glucose cotransporter 2 inhibitors (SGLT2is) has not been systematically evaluated. Therefore, in this review, we summarized the value of the TyG index and its related parameters as markers of CVD, especially HF. Furthermore, we addressed the use of SGLT2is and GLP-1 receptor antagonists in HF patients. Finally, we summarized the mechanism of the “obesity paradox.”

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The Safety and Efficacy of GLP-1 Receptor Agonists in Heart Failure Patients: A Systematic Review and Meta-Analysis

Cited by 13 publications

References 23 publications

The Negative Impact of Insulin Resistance/Hyperinsulinemia on Chronic Heart Failure and the Potential Benefits of Its Screening and Treatment

The Negative Impact of Insulin Resistance/Hyperinsulinemia on Chronic Heart Failure and the Potential Benefits of Its Screening and Treatment

Insulin resistance/hyperinsulinemia: an important cardiovascular risk factor that has long been underestimated

Value of the triglyceride–glucose index and related parameters in heart failure patients

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