August 2013, Vol 6 ADA 2013 Highlights - Emerging Therapies
Wayne Kuznar

San Francisco, CA—Medications that act on the glucagon-like peptide (GLP)-1 pathway may protect patients with type 2 diabetes from developing heart failure, according to a single-center retrospective study.

The study showed a reduced risk of heart failure–related hospitalization and all-cause mortality in patients with type 2 diabetes who had no history of heart failure and were prescribed GLP-1 agonists or dipeptidyl peptidase (DPP)-4 inhibitors, said David E. Lanfear, MD, Senior Staff Cardiologist, Henry Ford Hospital, Detroit, MI, at the 2013 American College of Cardiology annual meeting.

“Studies in animal models showed that GLP-1 drugs may have a beneficial impact on heart failure, such as increasing cardiac output,” Dr Lanfear said. “Two small human studies have also been consistent with this, so we decided to look at it in a larger population that did not have heart failure, but we know that diabetics are at higher risk of developing heart failure.”

The 4227 patients included in this analysis received care through the Henry Ford Health System and its affiliated HMO. The patients had an oral antidiabetic medication filled between January 1, 2000, and July 1, 2012, and were free of heart failure at baseline. Electronic databases were used to track medication use and outcomes. Patients receiving thiazolidinediones were excluded from the analysis.

Patients who started treatment with a GLP-1 agonist were matched in a 1 to 2 ratio to controls, using propensity score matching for age, sex, history of coronary artery disease or heart failure, duration of diabetes, and number of antidiabetic medications.

Over an observation period of 663 days, 281 hospitalizations occurred, including 184 hospitalizations for heart failure and 158 total deaths. The risk of a heart failure–related hospitalization was reduced by 41% among patients who used GLP-1 agonists compared with other classes of antidiabetes medications. The group of patients taking a GLP-1 agonist also had a 44% reduction in the risk of all-cause hospitalization and an 80% reduction in the risk of all-cause death.

The use of antihypertensive medications did not influence the effect of the GLP-1 drugs on heart failure risk.

“This study doesn’t tell us anything definitively, but it looks like these medicines are protective or may have favorable cardiac effects, particularly in terms of heart failure,” said Dr Lanfear. “It definitely makes further investigation a higher priority.”

The study offers some reassurance about the safety of GLP-1 drugs “but real safety data are coming and will take a couple of years,” he said. Further study will also explore the potential mechanisms behind the cardiovascular effects of these agents and the effects of GLP-1 agonists versus DPP-4 inhibitors.

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Last modified: October 8, 2013
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