Llongueras-Espí Pasqual, García-Romero Elena, Comín-Colet Josep, González-Costello José
Advanced Heart Failure and Heart Transplant Program, Cardiology Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, 08907 Barcelona, Spain.
Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute, L'Hospitalet de Llobregat, 08908 Barcelona, Spain.
Biomolecules. 2025 Sep 19;15(9):1342. doi: 10.3390/biom15091342.
Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are widely used in the management of type 2 diabetes and obesity due to their metabolic benefits. Beyond weight loss and glycemic control, emerging evidence suggests they may also exert cardioprotective effects. In the context of heart failure (HF), particularly HF with preserved ejection fraction (HFpEF), GLP-1RAs have been associated with improvement in symptoms, physical capacity, biomarkers, and structural cardiac remodeling. These benefits appear to be independent of weight loss, suggesting additional mechanisms including anti-inflammatory effects, improved myocardial metabolism or modulation of epicardial adipose tissue. However, current data largely come from non-HF dedicated trials, with limited standardization of the HF phenotype. Results are overall inconsistent and may suggest potential harm in some cases, particularly in HF with reduced ejection fraction (HFrEF). This review aims to summarize the current evidence on the role of GLP-1RAs in heart failure, explore possible underlying mechanisms and highlight key gaps in knowledge.
胰高血糖素样肽-1受体激动剂（GLP-1RAs）因其代谢益处而广泛应用于2型糖尿病和肥胖症的管理。除了减肥和血糖控制外，新出现的证据表明它们可能还具有心脏保护作用。在心力衰竭（HF）的背景下，尤其是射血分数保留的心力衰竭（HFpEF），GLP-1RAs与症状改善、身体能力、生物标志物和心脏结构重塑有关。这些益处似乎与体重减轻无关，提示存在其他机制，包括抗炎作用、改善心肌代谢或调节心外膜脂肪组织。然而，目前的数据主要来自非HF专项试验，HF表型的标准化有限。结果总体上不一致，在某些情况下可能提示潜在危害，尤其是在射血分数降低的心力衰竭（HFrEF）中。本综述旨在总结目前关于GLP-1RAs在心力衰竭中作用的证据，探讨可能的潜在机制，并突出知识上的关键空白。
