GLP-1 Receptor Agonists Demonstrate Benefits in Heart Failure with Preserved or Mildly Reduced Ejection Fraction

Heart failure (HF) remains a significant global health burden, characterized by high morbidity and mortality. Traditional treatments often fall short, especially for heart failure with preserved or mildly reduced ejection fraction (HFpEF/HFmrEF), where therapeutic options are more limited compared to heart failure with reduced ejection fraction (HFrEF). Glucagon-like peptide-1 receptor agonists (GLP-1 RAs), initially developed for type 2 diabetes, have demonstrated cardiovascular benefits in high-risk diabetic and obese patients. This review explores their emerging role in addressing the unmet needs of HF patients, particularly those with HFpEF/HFmrEF, by leveraging their established cardiometabolic effects.

This review article synthesized current evidence on glucagon-like peptide-1 receptor agonists (GLP-1 RAs), specifically focusing on their therapeutic role in heart failure (HF). The authors systematically summarized findings from key clinical trials and observational studies, particularly those involving semaglutide and tirzepatide, to evaluate their impact on HF outcomes. The review also provided practical guidance for the prescription, dosing, and follow-up of these therapies in clinical practice, aiming to bridge the gap between research findings and clinical application for patients with HF.

The review highlights that GLP-1 RAs have moved beyond their established benefits in type 2 diabetes and obesity to show significant promise in heart failure. Specifically, semaglutide and tirzepatide have demonstrated benefits in obese patients diagnosed with heart failure with preserved or mildly reduced ejection fraction (HFpEF/HFmrEF). These benefits include a reduction in HF hospitalizations and notable improvements in patient symptoms and functional capacity. The mechanism is thought to involve improvements in metabolic parameters, weight loss, and potential direct cardiac effects, though specific GLP-1R signaling in cardiac tissue is still under investigation. However, the review also points out that data regarding the efficacy of GLP-1 RAs in heart failure with reduced ejection fraction (HFrEF) remain limited, indicating a clear area for future research. The overall synthesis suggests a growing role for these agents in managing specific HF phenotypes. Semaglutide and tirzepatide have demonstrated benefits in obese patients with heart failure (HF) with preserved or mildly reduced ejection fraction, including fewer HF hospitalisations and improvements in symptoms and functional capacity.