Glucagon-like peptide-1 receptor agonists across the spectrum of heart failure.

Glucagon-like peptide-1 receptor agonists (GLP-1 RA) have been used to reduce body weight in overweight or people with obesity and to improve glycemic control and cardiovascular outcomes among people with type 2 diabetes (T2D) and a high cardiovascular risk. However, the effects of GLP-1 RA may be modified by the presence of heart failure (HF). In this review, we summarize the evidence for the use of GLP-1 RA across patient's risk with a particular focus in HF. After a careful review of the literature, we challenge the current views about the use of GLP-1 RA and suggest performing an active HF screening (with directed clinical history, physical examination, an echocardiogram, and natriuretic peptides) before initiating a GLP-1 RA. After HF screening, we suggest GLP-1 RA treatment decisions as follows: 1) in people with T2D without HF, GLP-1 RA should be used for reducing the risk of myocardial infarction and stroke, with a possible effect to reduce the risk of heart failure hospitalizations; 2) in patients with a heart failure and preserved ejection fraction (HFpEF), GLP-1 RA do not reduce HF hospitalizations but may reduce atherosclerotic events, and their use may be considered in an individualized manner; and 3) in patients with heart failure and reduced ejection fraction (HFrEF), the use of GLP-1RA warrants caution due to potential risk of worsening HF events and arrhythmias, pending risk-benefit data from further studies.