GLP-1 Receptor Agonists Linked with Lower Right Heart Failure Risk
GLP-1 receptor agonists (GLP-1 RAs) significantly reduced the risk of right heart failure in patients with pulmonary arterial hypertension (PAH) compared with sodium-glucose cotransporter-2 inhibitors (SGLT2-i), according to results from a large real-world analysis.
Comparing Cardioprotective Effects in Pulmonary Arterial Hypertension
PAH is a severe, progressive disease marked by pulmonary vascular remodeling and right ventricular dysfunction. Both GLP-1 RAs and SGLT2-i have demonstrated cardiovascular benefits in people with type 2 diabetes, prompting researchers to explore whether these effects extend to PAH. In this study, adults with PAH treated with either GLP-1 RAs or SGLT2-i were followed over several years to assess mortality, respiratory failure, and heart failure outcomes.
GLP-1 Therapy Shows Advantage in Right Heart Function
No significant difference was observed in all-cause mortality (RR 0.906, 95% CI 0.724–1.135) or respiratory failure (RR 0.929, 95% CI 0.689–1.253) between treatment groups. However, GLP-1 RAs were associated with a markedly reduced risk of right heart failure compared with SGLT2-i (RR 0.464, 95% CI 0.27–0.798, p = 0.0043).
Patients in the GLP-1 RA group also exhibited substantially lower mean brain natriuretic peptide (BNP) levels (338 versus 829), suggesting decreased cardiac stress and improved right ventricular performance.
Implications for PAH Management
Lead investigator Saud Alawad, MBBS, noted that GLP-1 RAs’ cardioprotective effect highlights “a potential new therapeutic direction” for PAH. While survival outcomes were comparable, the enhanced right ventricular outcomes point to a possible clinical advantage for GLP-1 RAs in this patient population.
These findings suggest that GLP-1 RAs may offer additional benefit over SGLT2-i for preserving right heart function in PAH, warranting further investigation in future clinical studies.
Reference: CHEST. GLP-1 Receptor Agonists Reduce Right Heart Failure Risk Compared to SGLT2 Inhibitors in Pulmonary Arterial Hypertension. 2025. Available at: https://www.chestnet.org/-/media/documents/news/glp-1-receptor-agonists-reduce-right-heart-failure-risk-compared-to-sglt2-inhibitors-in-pulmonary-arterial-hypertension.ashx. Last accessed: October 23, 2025.
