Heart failure patients may benefit from weight loss drug

The weight-loss drug semaglutide may help prevent heart attacks and other major adverse cardiac events (MACE) in people who are obese and have cardiovascular disease. heart failureAccording to a new study published in 2011, Lancet.¹

In a recent analysis of the SELECT trial, researchers reported that semaglutide 2.4 mg (Wegovy, Novo Nordisk), a glucagon-like peptide-1 (GLP-1) receptor agonist approved for weight loss, significantly reduced the risk of MACE and heart failure in patients with atherosclerotic cardiovascular disease and overweight or obesity, regardless of the presence or type of heart failure. The full study included more than 17,600 participants, about a quarter of whom had a history of heart failure, and all patients were aged 45 years or older, had a body mass index (BMI) of at least 27 kg/m², and had a history of cardiovascular disease. Patients were randomized to receive semaglutide 2.4 mg or a placebo.

GLP-1 receptor agonists were effective in both types of heart failure | Image credit: Ole – stock.adobe.com

Focusing on the 4,286 patients who had heart failure at enrollment, 53% had heart failure with preserved ejection fraction (HFpEF), 31.4% had heart failure with reduced ejection fraction (HFrEF), and 15.5% had unspecified heart failure. Patients with and without heart failure had similar baseline characteristics, but patients with heart failure had a higher incidence of clinical events.

After taking semaglutide, patients with heart failure had a 28% reduced risk of MACE and a 21% reduced risk of the composite heart failure endpoint of cardiovascular death, cardiovascular hospitalization or emergency hospitalization for heart failure compared to patients without heart failure. In addition, there was a 24% reduced risk of cardiovascular death alone and a 19% reduced risk of all-cause mortality.

GLP-1 receptor agonists were effective in both types of heart failure. In HFrEF patients, the risk of MACE was reduced by 35%, whereas in HFpEF patients, it was reduced by 31%. Nevertheless, HFrEF patients experienced more cardiac-related events overall compared to HFpEF patients. Furthermore, the risk of composite heart failure events was reduced by 21% in the HFrEF group and 25% in the HFpEF group.

Notably, the benefits of semaglutide were consistent regardless of patient factors such as age, sex, BMI, severity of heart failure or diuretic use. Patients who took semaglutide also experienced fewer serious adverse events compared with those who took placebo, regardless of their type of heart failure.

These results are in line with an earlier study by the same team, which found that in obese or overweight people with cardiovascular disease, weekly semaglutide injections reduced MACEs such as heart attacks and strokes by 20%.² Obese patients are at increased risk of cardiovascular disease and heart failure, but this risk is often underestimated, and patients with HFrEF who also have obesity have a worse prognosis.¹ This analysis of the SELECT trial found that semaglutide provided significant benefit to patients with atherosclerotic cardiovascular disease and overweight or obesity, regardless of their heart failure status.

“The observed benefits from semaglutide were seen in addition to usual treatment recommendations during the study period and may represent a new clinical opportunity,” the researchers note. “In many countries, patients with clinical atherosclerotic cardiovascular disease are often overweight or obese, and its incidence is increasing.”

This adds to previous findings showing that semaglutide also improves heart failure symptoms and exercise function, supporting its potential as a valuable treatment option.

“For the first time to our knowledge, we show that patients with atherosclerotic cardiovascular disease, overweight or obesity, and heart failure with reduced ejection fraction (who were at highest absolute risk) demonstrated a significant reduction in MACE with semaglutide, and the treatment effect on heart failure composite was observed to be similar to that seen in patient populations with heart failure with preserved ejection fraction,” the researchers said. “This result contrasts with previous small studies of the GLP-1 receptor agonist liraglutide, LIVE and FIGHT, which were not restricted to obese patients and were not sufficiently powered to evaluate clinical outcomes.”

References

1. Deanfield J, Verma S, Scirica BM, et al. Semaglutide and cardiovascular outcomes in patients with obesity and heart failure: a prespecified analysis of the SELECT trial. LancetPublished online August 24, 2024. doi:10.1016/S0140-6736(24)01498-3

2. Cardiac Effects of Weight Loss Drugs Extend to Heart Failure Patients. News Release. University College London. August 22, 2024. Accessed August 23, 2024. https://www.eurekalert.org/news-releases/1055249