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

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,  = 0.78], cardiovascular mortality (OR = 0.93, 95% CI: 0.22-4.00,  = 0.92) and worsening heart failure events (OR=0.43, 95% CI: 0.30-0.59,  < 0.00001); For secondary outcomes, change in body weight (MD = -7.90, 95% CI: -15.44 to -0.35,  = 0.04), change in the KCCQ-CSS (MD = 6.81, 95% CI: 6.62-6.99,  < 0.00001),change in the 6-minute walk distance (MD = 15.91, 95% CI: 15.36-16.47,  < 0.00001), change in the BNP level (MD = -0.13, 95% CI: -0.21 to -0.05,  = 0.001), changes in the hs-CRP level (MD = -16.61, 95% CI: -48.53 to 15.31,  = 0.31) and change in the LVEF level (MD = -0.91, 95% CI: -2.12 to 0.29,  = 0.14). For safety outcomes, gastrointestinal adverse events (OR=0.87, 95% CI: 0.11-7.05,  = 0.90) and serious adverse events (OR=0.63, 95% CI: 0.37-1.08,  = 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.