Glucagon-Like Peptide-1 Receptor Agonists in Obese Heart Failure With Preserved Ejection Fraction.

GLP-1 receptor agonist initiation was associated with a lower risk of all-cause mortality or heart failure hospitalization compared with DPP4 inhibitors/sulfonylureas.

• Adjusted hazard ratio, 0.78 (95% CI, 0.64-0.95), P=0.01.
• Median follow-up was 1.5 years.
• Inverse probability of treatment weighting based on the propensity score was used to balance baseline characteristics.

Only a small fraction of the screened HFpEF population with type 2 diabetes and obesity met the inclusion criteria for the new-user, active-comparator analysis.

• Among 179,288 patients with type 2 diabetes, obesity, and HFpEF, 1024 GLP-1RA users and 796 DPP4 inhibitor/sulfonylurea users met inclusion criteria.
• Patients were identified in the national VA Health System (170 US hospitals) with a validated diagnostic algorithm for HFpEF and BMI ≥30 kg/m2.
• Exposure was initiation between January 1, 2015 and December 31, 2021.

Weight loss was modestly greater with GLP-1RAs than with DPP4 inhibitors/sulfonylureas.

• Weight change was -12.9% with GLP-1RAs versus -10.1% with DPP4 inhibitors/sulfonylureas.

The study used a nationwide multicenter new-user, active-comparator cohort design in the Veterans Affairs Health System.

• Adults with type 2 diabetes between January 1, 2000 and December 31, 2021 were identified from centralized electronic health records.
• The primary outcome was time to all-cause mortality or heart failure hospitalization.
• The comparator was DPP4 inhibitors or sulfonylureas rather than no treatment.