Semaglutide, a medication originally developed for diabetes, has shown promising results in a recent clinical trial for weight loss and improved heart function in patients with heart failure with preserved ejection fraction (HFpEF) and obesity. This groundbreaking study, published in the New England Journal of Medicine, offers new hope for this challenging patient population.
Image: Representation of a healthy heart.
Obesity is a significant contributing factor to HFpEF, a condition where the heart’s ability to fill with blood is impaired. This often leads to worse functional capacity, reduced quality of life, increased hospitalizations, and even a higher risk of death. Effective treatments for HFpEF, particularly those addressing obesity, are urgently needed.
The STEP-HFpEF Trial: Evaluating Semaglutide’s Impact
The STEP-HFpEF (Effect of Semaglutide 2.4 mg Once Weekly on Function and Symptoms in Subjects with Obesity-related Heart Failure with Preserved Ejection Fraction) trial investigated the effects of semaglutide on HF-related symptoms, physical limitations, and weight loss in this specific patient group.
The randomized, placebo-controlled trial involved 529 patients with HFpEF and a body mass index (BMI) of 30 or greater. Participants received either once-weekly semaglutide (2.4 mg) or a placebo for 52 weeks. The primary endpoints were the change in the Kansas City Cardiomyopathy Questionnaire clinical summary score (KCCQ-CSS), which measures physical limitations, and the change in body weight.
Significant Improvements in Symptoms and Weight Loss
After one year, the results were remarkable. Patients receiving semaglutide experienced a significant improvement in their KCCQ-CSS score, with an average increase of 16.6 points compared to 8.7 points in the placebo group. This indicates a substantial reduction in physical limitations and improvement in overall heart function.
Furthermore, the semaglutide group achieved a significant weight loss of 13.3% of their body weight, while the placebo group lost only 2.6%. This five-fold difference highlights the potential of semaglutide as a powerful weight-loss agent in this population.
Secondary Endpoints and Safety Profile
Key secondary endpoints included changes in the six-minute walk distance, a composite of death, HF events, and changes in KCCQ-CSS and six-minute walk distance, and changes in C-reactive protein (CRP) levels. Semaglutide demonstrated favorable outcomes across all these measures, suggesting a positive impact on both weight and the underlying disease processes of HFpEF.
Importantly, the trial also assessed the safety of semaglutide. Fewer patients in the semaglutide group experienced serious adverse events compared to the placebo group (13.3% vs. 26.7%), further supporting its potential benefits.
Implications for Future Treatment
The findings of the STEP-HFpEF trial offer encouraging prospects for managing HFpEF in patients with obesity. Semaglutide’s ability to induce substantial weight loss and improve both physical function and heart-related symptoms represents a significant advancement in the field. Further research will explore the applicability of these findings to other weight loss interventions and patient populations.
Conclusion: A New Hope for HFpEF Patients
The results of this study suggest that semaglutide may be a valuable therapeutic option for individuals with HFpEF and obesity. By addressing both weight and the underlying pathophysiological processes contributing to HFpEF, semaglutide offers a comprehensive approach to improving the quality of life and potentially reducing the risk of adverse outcomes in these patients. Consult with a healthcare professional to discuss whether semaglutide is an appropriate treatment option for your specific situation.
Reference:
Kosiborod MN, Abildstrøm SZ, Borlaug BA, et al. Semaglutide in Patients with Heart Failure with Preserved Ejection Fraction and Obesity. N Engl J Med;2023; DOI: 10.1056/NEJMoa2306963.
