Glucagon-like peptide-1 receptor agonists for prevention of heart failure events in type 2 diabetes and/or obesity

Introduction Heart failure (HF) is a common sequela of diabetes and obesity. Glucagon-like peptide-1 (GLP-1) receptor agonists may prevent HF events. This meta-analysis estimates absolute risk reduction (ARR) and number needed to treat (NNT) for GLP-1 receptor agonists to prevent one HF event in patients with type 2 diabetes and/or obesity, including those without baseline HF.

Methods The Medline, Embase, and Cochrane Central databases were searched to 04 April 2025 for placebo-controlled randomized controlled trials (RCTs) of GLP-1 receptor agonists in a type 2 diabetes and/or obesity indication with a prespecified HF event endpoint. Random effects meta-analysis using the Mantel-Haenszel Method was performed to synthesize risk ratios (RR), ARRs, and NNTs with 95% confidence intervals (CI).

Results Twelve placebo-controlled RCTs involving 95 023 patients were included. GLP-1 receptor agonists reduced HF events by 12% (RR 0.88, 95% CI 0.82–0.95; ARR 0.42%, 95% CI 0.17%–0.62%; NNT 238, 95% CI 161–588), and, in those without baseline HF, by 19% (RR 0.81, 95% CI 0.72–0.90; ARR 0.60%, 95% CI 0.32%-0.89%; NNT 167, 95% CI 113–313). Semaglutide reduced the risk of HF events by 16% (RR 0.84, 95% CI 0.74–0.95; ARR 0.62%, 95% CI 0.19%-1.00%; NNT 161, 95% CI 100–526), and by 31% in those without baseline HF (RR 0.69, 95% CI 0.55–0.88; ARR 1.25%, 95% CI 0.48%-1.82%; NNT 80, 95% CI 55–208).

Conclusion GLP-1 receptor agonists have limited absolute benefit for preventing HF events in patients with type 2 diabetes and/or obesity, including in those without baseline HF.

Systematic review registration PROSPERO: CRD420251074882