In Reply As highlighted by Mr Carbone and colleagues, comparing the FIGHT study with other recent trials of GLP-1 agonists raises interesting questions about how heart failure severity might affect GLP-1 response. Although the FIGHT study enrolled few patients with NYHA IV functional capacity (29% NYHA II, 63% NYHA III, and 5% NYHA IV), the patients enrolled clearly had more advanced heart failure (late American Heart Association/American College of Cardiology [AHA/ACC] stage C) than those in the LEADER study1 (mostly AHA/ACC stage A and B) or the Evaluation of Lixisenatide in Acute Coronary Syndrome (ELIXA) trial,2 which enrolled patients with a recent acute coronary event (early AHA/ACC stage C). There are many important distinctions among these and other recent trials of GLP-1 agonists for patients with type 2 diabetes.3 Nevertheless, the overall signal that seems to emerge is a reduction in cardiovascular outcomes among patients at risk for structural heart disease, a lack of effect on heart failure outcomes among those with early cardiac remodeling, and possible detrimental effects on heart failure outcomes in patients with advanced symptomatic heart failure.
Kenneth B. Margulies, Steven E. McNulty, Thomas P. Cappola. Lack of Benefit for Liraglutide in Heart Failure—Reply. JAMA. 2016;316(22):2429–2430. doi:10.1001/jama.2016.15394