Dulaglutide and cardiovascular and heart failure outcomes in patients with and without heart failure: a post-hoc analysis from the REWIND randomized trial.

Kelley R H Branch; Gilles R Dagenais; Alvaro Avezum; Jan Basile; Ignacio Conget; William C Cushman; Petr Jansky; Mark Lakshmanan; Fernando Lanas; Lawrence A Leiter; Prem Pais; Nana Pogosova; Peter J Raubenheimer; Lars Ryden; Jonathan E Shaw; Wayne H H Sheu; Theodora Temelkova-Kurktschiev; M Angelyn Bethel; Hertzel C Gerstein; Ramasundarahettige Chinthanie; Jeffrey L Probstfield
Abstract
People with diabetes are at high risk for cardiovascular events including heart failure (HF). We examined the effect of the glucagon-like peptide 1 agonist dulaglutide on incident HF events and other cardiovascular outcomes in those with or without prior HF in the randomized placebo-controlled Researching Cardiovascular Events with a Weekly Incretin in Diabetes (REWIND) trial.The REWIND major adverse cardiovascular event (MACE) outcome was the first occurrence of a composite endpoint of non-fatal myocardial infarction, non-fatal stroke, or death from cardiovascular causes (including unknown causes). In this post-hoc analysis, a HF event was defined as an adjudication-confirmed hospitalization or urgent evaluation for HF. Of the 9901 participants studied over a median follow-up of 5.4 years, 213/4949 (4.3%) randomly assigned to dulaglutide and 226/4952 (4.6%) participants assigned to placebo experienced a HF event (hazard ratio [HR] 0.93, 95% confidence interval [CI] 0.77-1.12; p = 0.456). In the 853 (8.6%) participants with HF at baseline, there was no change in either MACE or HF events with dulaglutide as compared to participants without HF (p = 0.44 and 0.19 for interaction, respectively). Combined cardiovascular death and HF events were marginally reduced with dulaglutide compared to placebo (HR 0.88, 95% CI 0.78-1.00; p = 0.050) but unchanged in patients with and without HF at baseline (p = 0.31).Dulaglutide was not associated with a reduction in HF events in patients with type 2 diabetes regardless of baseline HF status over 5.4 years of follow-up.
Journal EUROPEAN JOURNAL OF HEART FAILURE
ISSN 1879-0844
Published 01 Oct 2022
Volume 24
Issue 10
Pages 1805 1812 1805-1812
DOI 10.1002/ejhf.2670
Type Randomized Controlled Trial | Journal Article | Research Support, Non-U.S. Gov't
Sponsorship NHMRC: 1173952