Adding GLP-1 RA to SGLT2i Reduces Mortality and Hospitalization in Heart Failure and ASCVD Patients: Study

"The findings revealed that in patients with ASCVD and heart failure, the addition of GLP-1 RAs to SGLT2i was associated with a 28% reduction in one-year mortality (HR: 0.72) and a 22% decrease in hospitalization rates (HR: 0.78) compared to SGLT2i alone. Also, the risk of heart failure exacerbations declined by 23% (HR: 0.77)," the researchers reported in European Heart Journal - Cardiovascular Pharmacotherapy. The combination therapy demonstrated consistent benefits across different heart failure subtypes and comorbid conditions.

The researchers note that managing patients with ASCVD and HF remains a significant clinical challenge. Both SGLT2 inhibitors and GLP-1 receptor agonists have demonstrated cardiovascular benefits individually, yet the potential advantages of their combined use remain unclear. To address this gap, Yu-Min Lin, Division of Cardiology, Department of Internal Medicine, Chi Mei Medical Centre, Chiali, Tainan, Taiwan, and colleagues assessed whether adding GLP-1 RAs to SGLT2i therapy could enhance outcomes in patients with ASCVD and HF.

For this purpose, the researchers conducted a retrospective observational study using the TriNetX database to evaluate patients with ASCVD and HF who initiated either GLP-1 RA alongside SGLT2i or SGLT2i alone between August 1, 2016, and September 30, 2024. Out of 2,797,317 identified patients, 96,051 met the inclusion criteria. Following propensity score matching, 5,272 patients were analyzed in each group. The primary outcomes assessed one-year mortality or hospitalization, while secondary outcomes included individual assessments of mortality, hospitalization, and heart failure exacerbation (HFE).

The key findings of the study were as follows:

• Patients receiving GLP-1 RA and SGLT2i had a significantly lower risk of mortality or hospitalization (HR 0.78) than those receiving SGLT2i alone.
• Mortality risk was reduced (HR 0.72) with the combination therapy.
• Hospitalization rates were lower (HR 0.78) in patients receiving both therapies.
• The risk of heart failure exacerbation declined (HR 0.77) with GLP-1 RA addition.
• Subgroup analyses showed consistent benefits across patients with HFpEF, HFrEF, diabetes, obesity, chronic kidney disease, or those using semaglutide or dulaglutide.
• Liraglutide use had a neutral effect on outcomes.
• Drug-related side effects were monitored, with no significant differences observed between the groups.

"The findings revealed that in patients with ASCVD and HF, the addition of GLP-1 RA to SGLT2i is associated with reduced one-year mortality and hospitalization, highlighting the need for further research across diverse populations," the researchers concluded.

Reference:

Chen, S., Wu, J., Liao, K., & Lin, Y. Prognostic Benefit of GLP-1 RA Addition to SGLT2i in Patients with ASCVD and Heart Failure: A Cohort Study. European Heart Journal - Cardiovascular Pharmacotherapy. https://doi.org/10.1093/ehjcvp/pvaf014