Objective To disuss the effect of glucagon like peptide-1 receptor (GLP-1R) agonist Exendin-4(E4) on injury of cardiomyocytes in the hyperglycemia and hyperlipidemia(HGHL) environment, and to clarify its related mechanism. Methods The H9C2 cardiomyocytes of the rats were divided into control group, HGHL group, HGHL+E4 group, HGHL+E4+iron death agonist(Erastin) group.The HGHL model of the H9C2 cells was induced by 33 mmol·L-1 glucose and 500 μmol·L-1 palmitate,and the cells in HGHL+E4 group and HGHL+E4+Erastin group were treated with 100 nmol·L-1 E4 and 5 μmol·L-1 Erastin. CCK-8 assay was used to detect the survival rates of cells in various groups; Hoechst 33258 fluorescence staining was used to observe the apoptosis of cells in various groups; flow cytometry was used to detected the apoptotic rates of cells in various groups;2',7'-dichlorodihydrofluorescein diacetate(DCFH-DA) fluorescence probe was used to detect the levels of reactive oxygen species (ROS) in the cells in various groups; the corresponding kit was used to detect the levels of glutathione (GSH) and malondialdehyde (MDA) in cells in various groups;JC-1 staining was used to detect the mitochondrial membrane potential (MMP) in cells in various groups; FerroOrange fluorescence probe was used to detect the levels of Fe2+ in the cells in various groups; Western blotting method was used to detect the expression levels of glutathione peroxidase 4 (GPX4) and solute carrier family 7 member 11(SLC7A11) in the cells in various groups. Results Compared with control group, the survival rate of cells in HGHL group was decreased (P<0.05),and the cells were fragmented and collapsed, which showed apoptotic morphology;the apoptotic rate and the levels of ROS and MDA in the cells were increased(P<0.05), the levels of GSH and MMP were decreased(P<0.05), the level of Fe2+ was increased(P<0.05),and the expression levels of GPX4 and SLC7A11 proteins were decreased(P<0.05).Compared with HGHL group, the survival rate of the cells in HGHL+E4 group was increased (P<0.05),and the apoptosis was decreased;the apoptotic rate and the levels of ROS and MDA were decreased(P<0.05), while the levels of GSH and MMP were increased(P<0.05), the level of Fe2+ was decreased(P<0.05), and the expression levels of GPX4 and SLC7A11 proteins were decreased (P<0.05).Compared with HGHL+E4 group, the survival rate of the cells in HGHL+E4+Erastin group was decreased(P<0.05), the cell fragmentation and wrinkling were obviously decreased,the apoptotic rate and the levels of ROS and MDA were increased(P<0.05), the levels of GSH and MMP were decreased(P<0.05), the level of Fe2+ was increased(P<0.05),and the expression levels of GPX4 and SLC7A11 proteins were decreased(P<0.05). Conclusion GLP-1R agonists can reduce the cardiomyocyte injury in the HGHL environment, and the protective effect may be related to inhibiting the iron death.