Effects of semaglutide in heart failure with preserved ejection fraction – effect of weight reduction

Czech version

Authors: Ján Murín
Authors‘ workplace: I. interná klinika LF UK a UNB, Nemocnica Staré Mesto, Bratislava
Published in: Diab Obez 2024; 24(48): 125-130
Category: Reviews

Overview

Heart failure (HF) is a frequent and important disease and its incidence and prevalence is progressively increasing. Pathophysiology of HF with preserved ejection fraction (HFpEF) is less well known, but these patients are more elderly. Type 2 diabetes mellitus (T2DM) is here an important comorbidity, but obesity supposed to be a pre-diabetes, becomes also a new and important risk factor for HFpEF. In the STEP-HFpEF trial, semaglutide improved symptoms, physical limitations and exercise function, and reduced body weight in patients with obesity phenotype of HFpEF. This study examined the effects of semaglutide on dual primary endpoints (change in Kansas City Cardiomyopathy Questionnaire Score/KCCQ-S, and body weight) and on the confirmatory secondary endpoints (change in 6-minute walk distance – 6MWD), hierarchial composite events (death, HF events, change in KCCQ-S, 6MWD) and change in C-reactive protein (CRP) across obesity classes I-III (BMI 30.0–34.9, 35–39.9 and ≥ 40.0 kg/m²) and according to body weight reduction with semaglutide after 52 weeks. Semaglutide consistently improved all outcomes across obesity categories. In semaglutide–treated patients, improvements in KCCQ-S, 6MWD and CRP were greater with larger body weight reduction. In participants with obesity phenotype of HFpEF, semaglutide improved symptoms, physical limitations and exercise function and reduced inflammation and also body weight across obesity catogories. In semaglutide-treated patients, the magnitude of benefit was directly related to the extent of weight loss. Collectively, these data support semaglutide-mediated weight loss as a key treatment strategy in patients with obesity phenotype of HFpEF.

Keywords:

heart failure with preserved ejection fraction – improvement of clinical events in heart fail-ure – obesity phenotype of HFpEF – obesity reduction – semaglutide effects

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