From the Guidelines
Yes, several GLP-1 receptor agonists have demonstrated heart failure benefits, particularly semaglutide and liraglutide, which have shown reductions in major adverse cardiovascular events including heart failure in clinical trials 1.
Key Findings
- Semaglutide (Ozempic, Wegovy) has been associated with a reduction in heart failure hospitalizations in the SUSTAIN and PIONEER trials.
- Liraglutide (Victoza) has demonstrated a reduction in major adverse cardiovascular events including heart failure in the LEADER trial.
- Dulaglutide (Trulicity) has shown cardiovascular benefits in the REWIND trial.
Mechanism of Action
These medications work by:
- Improving glycemic control
- Promoting weight loss
- Reducing inflammation
- Having direct beneficial effects on the cardiovascular system
- Decreasing cardiac workload through blood pressure reduction and improved endothelial function
Treatment Recommendations
For patients with type 2 diabetes and established cardiovascular disease or multiple risk factors, GLP-1 agonists (particularly semaglutide) should be considered as part of the treatment regimen 1. Typical dosing involves:
- Weekly injections for semaglutide (0.25mg initially, titrated up to 0.5-1mg)
- Weekly injections for dulaglutide (0.75-1.5mg)
- Daily administration for liraglutide
Clinical Evidence
The most recent and highest quality study, the 2024 acc/aha/aacvpr/apma/abc/scai/svm/svn/svs/sir/vess guideline for the management of lower extremity peripheral artery disease, supports the use of GLP-1 agonists in patients with type 2 diabetes and established cardiovascular disease or multiple risk factors 1. Additionally, the 2025 standards of care in diabetes recommend the use of GLP-1 receptor agonists with demonstrated cardiovascular benefit as part of the comprehensive cardiovascular risk reduction and/or glucose-lowering treatment plans 1.
From the Research
GLP-1 Agonists and Heart Failure Benefits
- GLP-1 receptor agonists (GLP-1 RAs) have been shown to have potential benefits for patients with heart failure, particularly those with type 2 diabetes and high cardiovascular risk 2, 3, 4.
- The use of GLP-1 RAs has been associated with a reduction in cardiovascular events, including myocardial infarction and stroke, as well as a possible reduction in the risk of heart failure hospitalizations 2, 3, 4.
- However, the effects of GLP-1 RAs on heart failure may be modified by the presence of heart failure, and active heart failure screening is recommended before initiating GLP-1 RA treatment 2.
Specific Patient Populations
- In patients with heart failure and preserved ejection fraction, GLP-1 RAs may not reduce heart failure hospitalizations but may reduce atherosclerotic events, and their use may be considered in an individualized manner 2, 5.
- In patients with heart failure and reduced ejection fraction, the use of GLP-1 RAs warrants caution due to potential risk of worsening heart failure events and arrhythmias, pending risk-benefit data from further studies 2.
- GLP-1 RAs have been shown to reduce worsening heart failure events and the composite of cardiovascular death or worsening heart failure in patients with heart failure and mildly reduced or preserved ejection fraction, particularly in those with obesity or diabetes 5.
Comparison with Other Therapies
- SGLT2 inhibitors have been shown to have a beneficial impact on both systolic and diastolic function parameters in subjects with diabetes with and without heart failure, and may be considered for patients with heart failure and reduced ejection fraction 3, 6.
- GLP-1 RAs have been shown to be safe and marginally beneficial in subjects with type 2 diabetes without heart failure, but their role in heart failure prevention and treatment is still being evaluated 2, 6, 4.