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Network meta-analysis: GLP-1 drugs beat SGLT2 inhibitors for ejection fraction and heart attack prevention in heart failure

RPEP-136502025Song, Ruirui; Liu, Fang; Shi, Xiaojing; Sun, Songtao; Chen, Jun; Gao, Hongmei
evidence
The takeaway

In a network meta-analysis of SGLT2i, GLP-1RA, and DPP-4i in heart failure, GLP-1RA was superior to SGLT2i for improving LVEF and reducing MI/ACS, while DPP-4i was superior for LVEDV and LVESV improvement.

GLP-1RA best for LVEF + MI

Network meta-analysis reveals GLP-1 drugs improve heart pumping function and reduce heart attacks more than SGLT2 inhibitors in heart failure

What the researchers found

GLP-1RA > SGLT2i for LVEF and MI/ACS reduction. DPP-4i > SGLT2i for LVEDV and LVESV. Dapagliflozin/empagliflozin: best for HF rehospitalization vs liraglutide. Albiglutide: lowest CV death vs exenatide. Dose-dependent effects documented.

Why it matters

This is the first NMA comparing all three diabetes drug classes head-to-head at specific dose levels for heart failure outcomes, enabling more precise treatment selection based on the specific cardiac benefit needed.

How the study worked

Comprehensive systematic review and network meta-analysis of SGLT2i, GLP-1RA, DPP-4i at different doses for heart failure patients.

What this study cannot tell us

Network meta-analysis with indirect comparisons. Heterogeneous study populations and follow-up durations. Some comparisons based on few studies. DPP-4i results surprising and need verification.

How to read the evidence

Comprehensive NMA of multiple drug classes and doses. Strong methodology but relies on indirect comparisons.

When this study was published

Published in 2025.

The bigger picture

Different diabetes drug classes have different cardiac strengths. Rather than a one-size-fits-all approach, this analysis supports choosing the drug class based on the specific cardiac problem—pumping function (GLP-1RA), chamber size (DPP-4i), or hospitalization prevention (SGLT2i).

Questions still open

  • Should heart failure treatment be guided by specific cardiac deficits?
  • Is the GLP-1RA advantage for LVEF clinically meaningful?
  • Why do DPP-4i improve chamber volumes despite no guideline recommendation for HF?

Common questions

Which diabetes drug is best for the heart?
It depends on the specific cardiac problem. GLP-1 drugs improve how well the heart pumps (ejection fraction) and reduce heart attacks best. SGLT2 inhibitors prevent heart failure hospitalizations most effectively. DPP-4 inhibitors may reduce heart chamber enlargement. The ideal approach may combine multiple classes.
Should heart failure patients get GLP-1 drugs?
This analysis supports it, especially for patients needing improved heart pumping function or MI prevention. However, SGLT2 inhibitors remain important for preventing hospitalizations. Many patients may benefit most from using both drug classes together.

Read the original research

Effects of new hypoglycemic drugs on patients with heart failure: a systematic review and network meta-analysis.

Postgraduate medical journal, 101(1194), 330-350

View on PubMed ↗Publisher’s paper ↗

Citation

Song, Ruirui; Liu, Fang; Shi, Xiaojing; Sun, Songtao; Chen, Jun; Gao, Hongmei. (2025). Effects of new hypoglycemic drugs on patients with heart failure: a systematic review and network meta-analysis.. Postgraduate medical journal, 101(1194), 330-350. https://doi.org/10.1093/postmj/qgae148