T2D: even with heart failure, CV outcomes improve with liraglutide

  • Marso SP & al.
  • J Am Coll Cardiol
  • 17 Mar 2020

  • curated by Miriam Tucker
  • Clinical Essentials
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Takeaway

  • LEADER trial: liraglutide reduced major adverse cardiovascular events (MACE), nephropathy, and mortality vs placebo, without increased heart failure (HF) hospitalizations and regardless of baseline HF status.

Why this matters

  • Effects of glucose-lowering therapies in type 2 diabetes (T2D) on HF outcomes vary.

Study design

  • In multinational, double-blind, LEADER trial, 9340 patients with T2D and high cardiovascular risk were randomly assigned to liraglutide or placebo plus standard care and followed for 3.5-5 years.
  • At baseline, 18% had New York Heart Association (NYHA) functional class I-III HF history.
  • Funding: Novo Nordisk.

Key results

  • No significant interaction (HRs; 95% CIs) between liraglutide vs placebo and HF history for:
    • MACE:
      • With HF history: 0.81 (0.65-1.02). 
      • Without: 0.88 (0.78-1.00; Pinteraction=.53). 
    • All-cause death:
      • With HF history: 0.89 (0.70-1.14). 
      • Without: 0.83 (0.70-0.97; Pinteraction=.63).
  • No HF hospitalization increase with liraglutide:
    • With HF history: 0.98 (0.75-1.28).
    • Without: 0.78 (0.61-1.00; Pinteraction=.22).
  • Risk for nephropathy with liraglutide vs placebo:
    • With HF history: 0.77 (0.51-1.18).
    • Without: 0.78 (0.66-0.93).

Limitations

  • HF etiology, biomarker information not collected.
  • Not all endpoints were prespecified.
  • Not powered for all subgroup analyses.  
  • Possible medication differences between groups.
  • May not apply to lower-risk populations, or NYHA class IV.