Growth differentiation factor 15, treatment with liraglutide, and clinical outcomes among patients with heart failure

• Sharma A.
• Greene S.
• Muthiah V.
• Fudim M.
• Ambrosy A.P.
• McNulty S.E.
• Sun J.-L.
• Hernandez A.F.
• Borlaug B.A.
• Velazquez E.J.
• Mentz R.J.
• DeVore A.D.
• Alhanti B.
• Margulies K.
• Felker G.M.

Abstract

Aims. Associations between growth differentiation factor‑15 (GDF‑15), cardiovascular outcomes, and exercise capacity among patients with a recent hospitalization for heart failure (HHF) and heart failure with reduced ejection fraction (HFrEF) are unknown. We utilized data from the ‘Functional Impact of GLP‑1 for Heart Failure Treatment’ (FIGHT) study to address these knowledge gaps.

Methods and results. FIGHT was a randomized clinical trial testing the effect of liraglutide (vs. placebo) among 300 participants with HFrEF and a recent HHF. Multivariable regression models evaluated associations between baseline GDF‑15 and change in GDF‑15 (per 1000 pg/mL increase from baseline to 30 days) with clinical outcomes (at 180 days) and declines in exercise capacity (6 min walk distance ≥45 m). At baseline (n=249), median GDF‑15 value was 3221 pg/mL (interquartile range 1938–5511 pg/mL). Participants in the highest tertile of baseline GDF‑15 were more likely to be male and have more comorbidities.

After adjustment, an increase in GDF‑15 over 30 days was associated with higher risk of death or HHF [hazard ratio 1.35, 95% confidence interval (CI) 1.11–1.64]. In addition, higher baseline GDF‑15 (per 1000 pg/mL until 6000 pg/mL) and an increase in GDF‑15 over 30 days were associated with declining 6 min walk distance (odds ratio 1.26, 95% CI 1.02–1.55 and odds ratio 1.37, 95% CI 1.12–1.69, respectively). GDF‑15 levels remained stable among participants randomized to liraglutide.

Conclusions. An increase in GDF‑15 over 30 days among patients in HFrEF was independently associated with an increased risk of cardiovascular events and declining exercise capacity. These results support the value of longitudinal GDF‑15 trajectory in informing risk of heart failure disease progression.

Keywords:GDF-15; heart failure; liraglutide; GLP-1 receptor agonist

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