Understanding the Role of Glucagon-like Peptide-1 Receptor Agonists in the Treatment of Heart Failure

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs), initially developed for glycaemic control in patients with type 2 diabetes, have demonstrated significant cardiometabolic benefits beyond glucose regulation. These agents have multiple effects, including reducing body weight, improving insulin sensitivity, anti-inflammatory properties and enhancing endothelial function. All these mechanisms are potentially beneficial in patients with heart failure (HF), specifically those with HF with preserved left ventricular ejection fraction. Recent trials, including STEP-HFpEF and SUMMIT, underscore the efficacy of GLP-1 RAs in improving quality of life and exercise capacity, as well as possibly reducing major adverse cardiovascular events. Furthermore, these trials demonstrated improvements in other endpoints, such plasma N-terminal pro B-type natriuretic peptide, troponin and C-reactive protein concentrations, consistent with the beneficial effects of GLP-1 RAs on myocardial function and inflammation. Further data are needed regarding the effects of GLP-1 RAs on cardiovascular outcomes, and possibly in a broader range of patients with HF, such as those with HF reduced ejection fraction and/or patients without obesity.