Improving HF Outcomes in Obesity and Type 2 Diabetes: The Role of Semaglutide
Clinical question: Does semaglutide improve heart failure (HF) symptoms in patients with obesity-related HF and type 2 diabetes?
Background: Obesity-related HF and type 2 diabetes are prevalent coexisting conditions that significantly impact patient morbidity and mortality. Current treatment strategies have not adequately addressed the need for effective interventions targeting both weight management and cardiovascular health in this population. Semaglutide, a GLP-1 receptor agonist, has shown promise in weight reduction and metabolic control, but its efficacy in improving HF outcomes specifically in this group required investigation.
Study design: Double-blinded, randomized, controlled trial
Setting: International, multicenter, including academic and community hospitals
Synopsis: This study evaluated the effects of weekly semaglutide (2.4 mg) compared to placebo in patients with HF with preserved ejection fraction, obesity (BMI ≥30), and type 2 diabetes over 52 weeks. A total of 616 patients were randomly assigned to receive either treatment (semaglutide versus placebo). The primary outcomes included changes in the Kansas City Cardiomyopathy Questionnaire clinical summary score (KCCQ-CSS) and body weight. The semaglutide group experienced a significant improvement in KCCQ-CSS (mean change of 13.7 points versus 6.4 points for placebo; P <0.001) and a greater reduction in body weight (-9.8% versus -3.4%; P <0.001). Secondary outcomes also favored semaglutide, including improvements in functional capacity measured by the six-minute walk test and lower C-reactive protein levels. Notably, serious adverse events were less frequent in the semaglutide group (17.7%) compared to the placebo group (28.8%). The study’s limitations are that it excluded patients with severe renal impairment, had an underrepresentation of non-white participants, and had an overall short duration, which may affect the long-term applicability of the results.
Bottom line: Semaglutide is associated with significant weight loss and improved cardiovascular outcomes in patients with obesity-related HF and type 2 diabetes, including reduced HF symptoms and enhanced functional capacity.
Citation: Kosiborod MN, Petrie MC, et al. Semaglutide in patients with obesity-related heart failure and type 2 diabetes. N Engl J Med. 2024;390(15):1394-1407.
Dr. Carroll
Dr. Carroll is a hospitalist in the division of hospital medicine at NYU Langone Tisch Hospital and an assistant professor of medicine at the NYU Grossman School of Medicine, both in New York.