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The impact of the Glucagon-Like Peptide-1 Receptor Agonist Liraglutide on Natriuretic Peptides in Heart Failure Patients with Reduced Ejection Fraction with and without Type 2 Diabetes

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BACKGROUND: The Glucagon-like peptide-1 receptor agonist liraglutide improves prognosis in patients with type 2 diabetes (T2D). However, the clinical usefulness in heart failure patients with reduced ejection fraction (HFrEF) remains uncertain. The efficacy of liraglutide in HFrEF with and without T2D can be assessed by changes in the prognostic markers of neurohormonal activation; midregional-pro-atrial-natriuretic-peptide (MR-proANP) and N-terminal brain-natriuretic-peptide (NT-proBNP).

METHODS: In the LIVE study, patients (n=241) with LVEF≤45% were randomized to liraglutide 1.8 mg daily or placebo for 24 weeks, and 30% had a concomitant diagnosis of T2D. Plasma levels of NT-proBNP (predefined secondary endpoint), MR-proANP, midregional-pro-adrenomedullin (MR-proADM) and copeptin were measured at baseline and after 24 weeks in this sub-study. The potential effect modification of T2D was assessed.

RESULTS: In the eligible subgroup of 231 patients with available biomarkers (115 randomized to liraglutide and 116 to placebo), MR-proANP decreased by 12% (P=0.002) and NT-proBNP by 9% (P=0.009) during liraglutide treatment compared to placebo at week 24. Interaction with T2D for the treatment effect of change in MR-proANP and NT-proBNP levels were P=0.003 and P=0.03, respectively. Consequently, in patients with T2D, liraglutide decreased MR-proANP by 27% (P<0.001) and NT-proBNP by 25% (P=0.02) as compared with placebo, whereas no change was observed in patients without T2D. There was no effect of liraglutide on MR-proADM (P=0.10) or copeptin (P=0.52).

CONCLUSION: Liraglutide decreased the A- and B-type natriuretic peptides significantly in patients with HFrEF and concomitant T2D, suggesting a beneficial mechanism of liraglutide in T2D patients with HFrEF. This article is protected by copyright. All rights reserved.

OriginalsprogEngelsk
TidsskriftDiabetes, Obesity and Metabolism
ISSN1462-8902
DOI
StatusE-pub ahead of print - 6 jul. 2020

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This article is protected by copyright. All rights reserved.

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