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Dr Ajay Kumar, Patna 27 November 2018

GLP-1 may affect cardiac function indirectly through its actions on pancreatic islets to increase insulin secretion and inhibit glucagon secretion. Evidence points to a reduction in systolic BP with GLP-1 RAs. GLP-1 RAs also improve CV-risk biomarkers.
Several CVOTs have been conducted with GLP-1 RAs and some are still underway. In the LEADER trial, in the time-to-event analysis, the rate of the first occurrence of CV death, nonfatal MI or nonfatal stroke was lower with GLP-1 RA than with placebo.
In SUSTAIN 6 trial as well, the primary outcome of first occurrence of CV death, nonfatal MI or nonfatal stroke occurred in 6.6% in the GLP-1 RA group and in 8.9% in the placebo group.
Recently, in the HARMONY OUTCOMES trial, treatment with GLP-1 RA showed a 22% risk reduction vs. placebo for the primary MACE endpoint in T2DM patients with established CVD. Significant 25% risk reduction was also seen for MI.
CVOT impact on clinical guidelines – The ADA and EASD consensus guideline recommend a GLP-1 RA with proven CVD benefits among patients in whom ASCVD or HF predominates.
GLP-1 RAs are considered the first choice for patients who need greater glucose-lowering effect of an injectable medication.

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