Efficacy and safety of GLP-1 receptor agonists in the treatment of obese patients with chronic heart failure: a meta-analysis

Abstract

Objective: To investigate the efficacy and safety of Glucagon-Like Peptide-1 Receptor Agonists(GLP-1RAs) (Liraglutide, Semaglutide, Exenatide, Dulaglutide, Lixisenatide, and Tirzepatide) in obese patients with chronic heart failure (CHF). Method: A systematic search was performed in 3 databases (Pubmed, Embase, and Cochrane Library) for articles evaluating the effectiveness and safety of GLP-1RAs (Liraglutide, Semaglutide, Exenatide, Dulaglutide, Lixisenatide, and Tirzepatide) for the treatment of obese patients with CHF from the time the database was created until 5 January 2025. Meta-analyses were performed to evaluate: primary outcomes, including all-cause mortality, cardiovascular mortality, and worsening heart failure events; secondary outcomes, encompassing changes in body weight, Kansas City Cardiomyopathy Questionnaire Clinical Summary Score (KCCQ-CSS), 6-minute walk distance, B-type Natriuretic Peptide (BNP) level, high-sensitivity C-Reactive Protein (hs-CRP) level, and left ventricular ejection fraction (LVEF) level; and safety outcomes, specifically gastrointestinal adverse events and serious adverse events. Results: A total of 6 papers were included for Meta-analysis. The primary clinical outcomes: all-cause mortality [OR=0.89, 95% confidence interval (CI): 0.40–2.00, p = 0.78], cardiovascular mortality (OR = 0.93, 95% CI: 0.22–4.00, p = 0.92) and worsening heart failure events (OR=0.43, 95% CI: 0.30–0.59, p < 0.00001); For secondary outcomes, change in body weight (MD = −7.90, 95% CI: −15.44 to −0.35, p = 0.04), change in the KCCQ-CSS (MD = 6.81, 95% CI: 6.62–6.99, p < 0.00001),change in the 6-minute walk distance (MD = 15.91, 95% CI: 15.36–16.47, p < 0.00001), change in the BNP level (MD = −0.13, 95% CI: −0.21 to −0.05, p = 0.001), changes in the hs-CRP level (MD = −16.61, 95% CI: −48.53 to 15.31, p = 0.31) and change in the LVEF level (MD = −0.91, 95% CI: −2.12 to 0.29, p = 0.14). For safety outcomes, gastrointestinal adverse events (OR=0.87, 95% CI: 0.11–7.05, p = 0.90) and serious adverse events (OR=0.63, 95% CI: 0.37–1.08, p = 0.09). Conclusion: The study results show that GLP-1RAs significantly reduce the risk of worsening heart failure events and improve cardiac function, suggesting that GLP-1RAs are promising treatment options for obese patients with CHF.