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Cardiac Effects of GLP-1 RA

A small study examines the possibility of using GLP-1 RAs to improve ventricular ejection fraction in patients with STEMI.

A small study has found that the use of the glucagon-like peptide (GLP)-1 analogue liraglutide resulted in mild improvement in left ventricular ejection fraction in patients with acute ST-segment elevation myocardial infarction (STEMI).

This small, proof of concept study was published by Wei Ren Chen, MD, from the Department of Cardiology, PLA General Hospital of Beijing, China, and colleagues in the American Heart Journal.

According to the study, liraglutide has been reported to reduce cardiac rupture and infarct size in mouse studies and another GLP-1 analogue, exenatide, has been found to protect against ischemia-reperfusion injury and improve cardiac function in patients with STEMI.

Therefore, in this study, Chen and colleagues enrolled 92 patients who were scheduled to undergo percutaneous coronary intervention for STEMI and randomly assigned them to liraglutide or placebo for 7 days to evaluate the effects of liraglutide on left ventricular ejection fraction. Patients started the study drug 30 minutes before intervention and continued treatment for 7 days after the procedure.

At 3 months, the difference in the change of ejection fraction between the two study groups was +4.1% (P<0.001). The researchers found this difference to be even greater (+5.0%) in patients with a left ventricular ejection fraction of <50% at baseline.

The researchers noted a nonsignificant trend towards a lower rate of no-reflow in the patients assigned liraglutide (7% vs. 15%; P=0.20).

Patients assigned liraglutide also had improvements in endothelial and inflammatory markers. Troponin T levels were significantly lower in patients assigned liraglutide compared with placebo at 5 days (P<0.05). In addition, the difference in change of fasting glucose levels between liraglutide and placebo was also statistically significant (P<0.05). Finally, at 3 months, patients assigned liraglutide had significant reductions in serum high-sensitivity C-reactive protein and IL-6 levels compared with the control group.

In a discussion of their results, Chen and colleagues pointed out several limitations of the study, including its small size and short duration, which they say “was not sufficient to fully evaluate the efficacy of liraglutide in patients with STEMI.”

In addition, they pointed out that the majority of patients in the study had ejection fraction of <50%, which makes it difficult to generalize these results.

“Given that the small study population of this study seems to be underpowered to detect the effect of liraglutide in STEMI patients,” the researchers wrote. “A large scale multicenter study is needed to confirm the efficacy and safety of liraglutide in STEMI patients.”

Chen WR, et al. Effects of liraglutide on left ventricular function in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Am Heart J.  2015;170:845-854.