Heart Failure Prevention in Type 2 Diabetes: Comparative Effectiveness of GLP-1 Receptor Agonists vs. SGLT-2 and DPP-4 Inhibitors

Highlights

• Initiation of GLP-1 receptor agonists (GLP-1RAs) is associated with a 23% lower risk of hospitalization for heart failure (HHF) compared to DPP-4 inhibitors.
• In a direct real-world comparison, GLP-1RAs demonstrated comparable effectiveness to SGLT-2 inhibitors in preventing HHF, with a weighted hazard ratio of 1.02.
• The absolute risk reduction for HHF is most significant among patients with the highest baseline cardiovascular risk, suggesting a targeted approach for therapy escalation.
• Target trial emulation methodology provides robust evidence that bridges the gap between restrictive randomized controlled trials and heterogeneous observational data.

Background