Article (Scientific journals)
GLP-1 receptor agonists and heart failure in diabetes.
Scheen, André
2017In Diabetes and Metabolism, 43 Suppl 1, p. 2S13-2S19
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Keywords :
Cardiac function; Congestive heart failure; GLP-1 receptor agonist; LEADER; Liraglutide; Type 2 diabetes
Abstract :
[en] The prevalence of heart failure (HF) is increasing in patients with type 2 diabetes (T2D), and glucose-lowering agents have distinctive effects on the risk of developing HF that requires hospitalization. Such an increased risk has been consistently reported with thiazolidinediones (glitazones) and perhaps also with the dipeptidyl peptidase (DPP)-4 inhibitor saxagliptin (at least in SAVOR - TIMI 53), whereas a markedly decreased risk was highlighted with the sodium - glucose cotransporter type 2 (SGLT2) inhibitor empagliflozin in EMPA-REG OUTCOME. Yet, the effects of glucagon-like peptide-1 receptor agonists (GLP-1RAs) on myocardial function remain controversial. Whereas some promising observations have been reported in various animal models, the effects of GLP-1RAs on myocardial function in humans are more heterogeneous, while the positive effect on left ventricular ejection fraction (LVEF), if any, appears to be inconsistent and rather modest in most patients with HF. However, no increased risk of hospitalization for HF has been reported with GLP-1RAs in meta-analyses of phase-II/III trials (exenatide, albiglutide, dulaglutide, liraglutide), demonstrating the safety of this pharmacological class, and such findings have been confirmed by three large prospective cardiovascular outcome trials (ELIXA with lixisenatide, LEADER with liraglutide and SUSTAIN-6 with semaglutide). In particular, LEADER reported a trend towards a reduction in HF hospitalization (-13%, P = 0.14), together with a significant reduction in cardiovascular and all-cause mortality in patients with T2D at risk of cardiovascular disease. These results are reassuring in the face of the somewhat negative results of the FIGHT trial, which evaluated the effects of liraglutide in patients with advanced HF and low LVEF, such that further studies and caution are now required when using this agent to treat such patients in clinical practice.
Disciplines :
Cardiovascular & respiratory systems
Pharmacy, pharmacology & toxicology
Endocrinology, metabolism & nutrition
Author, co-author :
Scheen, André  ;  Université de Liège > Département des sciences cliniques > Département des sciences cliniques
Language :
English
Title :
GLP-1 receptor agonists and heart failure in diabetes.
Publication date :
2017
Journal title :
Diabetes and Metabolism
ISSN :
1262-3636
eISSN :
1878-1780
Publisher :
Elsevier Masson, Paris, France
Volume :
43 Suppl 1
Pages :
2S13-2S19
Peer reviewed :
Peer Reviewed verified by ORBi
Commentary :
(c) 2017 Elsevier Masson SAS. All rights reserved.
Available on ORBi :
since 11 May 2017

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