Obesity and heart failure with preserved ejection fraction – dapagliflozin also shows clinical benefit here

Summary

Obesity is common and associated with unique phenotypic features in heart failure with preserved ejection fraction (HFpEF). Understanding the efficacy and safety of new therapies in HFpEF patients with obesity is important. The effects of dapagliflozin were examined according to body mass index (BMI) in the HFpEF patients in the DELIVER trial. BMI was analyzed by WHO categories, and it ranged from 15.2 to 50 kg/m² with a mean value of 29.8 kg/m². The proportions of patients by WHO category were: normal weight 1 343 (21.5 %), overweight 2 073 (33.1 %), class I obesity 1 574 (25.2 %), class II obesity 798 (12.8) and class III obesity 415 (6.6 %). Compared with placebo, dapagliflozin reduced the risk of the primary outcome (worsening of HF and cardiovascular death) to a similar extent across these categories with HRs: 0.89, 0.87, 0.74, 0.78 and 0.72 respectively. The placebo corrected change in Kansas Questionnaire (total symptom scores) with dapagliflozin at 8 months was: 0.9, 2.5, 1.9, 2.7 and 8.6 points, respectively. The placebo corrected change in weight at 12 months was. -0.88, -0.65, -1.42, -1.17 and -2.5 kg, respectively. Obesity is common in patients with HFpEF and is associated with higher rates of HF hospitalization and worse health status. Treatment with dapagliflozin improves cardiovascular outcomes across the spectrum of BMI, leads to greater symptom improvement in patients with obesity, compared with those without, and has the additional benefit of causing modest weight loss.

Keywords:

obesity – body mass index – heart failure with preserved ejection fraction – cardiovascular mortality – symptomatology of heart failure – worsening of heart failure