Impact of semaglutide on weight and functional outcomes among obese heart failure patients: a propensity scores matching analysis.
Humans
Male
Female
Heart Failure
/ physiopathology
Retrospective Studies
Obesity
/ diagnosis
Weight Loss
/ drug effects
Treatment Outcome
Aged
Middle Aged
Glucagon-Like Peptides
/ therapeutic use
Time Factors
Propensity Score
Recovery of Function
Functional Status
Body Mass Index
Glucagon-Like Peptide-1 Receptor
/ agonists
Anti-Obesity Agents
/ therapeutic use
Glucagon-like peptide 1 receptor agonist
Heart failure
Semaglutide
Weight reduction
Journal
BMC cardiovascular disorders
ISSN: 1471-2261
Titre abrégé: BMC Cardiovasc Disord
Pays: England
ID NLM: 100968539
Informations de publication
Date de publication:
26 Oct 2024
26 Oct 2024
Historique:
received:
04
02
2024
accepted:
21
10
2024
medline:
27
10
2024
pubmed:
27
10
2024
entrez:
27
10
2024
Statut:
epublish
Résumé
Obesity is a common comorbidity in heart failure, yet effective pharmacological options for weight loss in these patients are limited. Semaglutide, a glucagon-like peptide 1 receptor agonist, has shown promise for weight reduction in obese adults. This study aims to evaluate semaglutide's impact on weight loss, functional status, and clinical outcomes in obese patients with heart failure. A retrospective analysis was conducted on all consecutive obese (BMI > 30 kg/m²) patients with heart failure at the University Hospital Bonn outpatient clinic from July 2019 to July 2022. Propensity score matching paired patients receiving semaglutide as an add-on therapy (SEMA) with those on medical therapy alone (Control). Among 1,942 patients with heart failure screened, 26 matched pairs were identified. At one year, the SEMA group exhibited significant weight loss, with a mean BMI reduction of -2.91 kg/m² (95% CI: -4.27 to -1.55; p < 0.001), while the control group showed a non-significant mean change of -0.41 kg/m² (95% CI: -1.08 to 0.26; p = 0.22). The difference in BMI between the two groups was statistically significant (mean difference: 3.42 kg/m², 95% CI: 1.43 to 5.42; p = 0.001). Improvements by at least one NYHA class were observed in 65% of the SEMA group (p < 0.001) compared to 15% of the control group (p = 0.18). The SEMA group also showed a significant increase in 6-minute walk distance (6MWD), with a mean difference of 75 m between the groups at one year (95% CI: 0.53 to 150.02; p = 0.049). NT-proBNP levels significantly decreased in the SEMA group (p < 0.001) compared to the control group (p = 0.78), with a statistically significant difference in NT-proBNP between the groups (p = 0.048). Both improvements in 6MWD and reductions in NT-proBNP were significantly correlated with BMI percentage reductions. Semaglutide was associated with significant weight reduction in obese patients with heart failure, accompanied by improved NYHA classification and 6-minute walk distance. Larger, multi-center trials and prospective, randomized controlled trials are warranted. These studies should focus on assessing long-term outcomes, optimizing dosage, and exploring the potential cardiovascular benefits beyond weight reduction.
Sections du résumé
BACKGROUND & OBJECTIVES
OBJECTIVE
Obesity is a common comorbidity in heart failure, yet effective pharmacological options for weight loss in these patients are limited. Semaglutide, a glucagon-like peptide 1 receptor agonist, has shown promise for weight reduction in obese adults. This study aims to evaluate semaglutide's impact on weight loss, functional status, and clinical outcomes in obese patients with heart failure.
METHODS
METHODS
A retrospective analysis was conducted on all consecutive obese (BMI > 30 kg/m²) patients with heart failure at the University Hospital Bonn outpatient clinic from July 2019 to July 2022. Propensity score matching paired patients receiving semaglutide as an add-on therapy (SEMA) with those on medical therapy alone (Control).
RESULTS
RESULTS
Among 1,942 patients with heart failure screened, 26 matched pairs were identified. At one year, the SEMA group exhibited significant weight loss, with a mean BMI reduction of -2.91 kg/m² (95% CI: -4.27 to -1.55; p < 0.001), while the control group showed a non-significant mean change of -0.41 kg/m² (95% CI: -1.08 to 0.26; p = 0.22). The difference in BMI between the two groups was statistically significant (mean difference: 3.42 kg/m², 95% CI: 1.43 to 5.42; p = 0.001). Improvements by at least one NYHA class were observed in 65% of the SEMA group (p < 0.001) compared to 15% of the control group (p = 0.18). The SEMA group also showed a significant increase in 6-minute walk distance (6MWD), with a mean difference of 75 m between the groups at one year (95% CI: 0.53 to 150.02; p = 0.049). NT-proBNP levels significantly decreased in the SEMA group (p < 0.001) compared to the control group (p = 0.78), with a statistically significant difference in NT-proBNP between the groups (p = 0.048). Both improvements in 6MWD and reductions in NT-proBNP were significantly correlated with BMI percentage reductions.
CONCLUSIONS
CONCLUSIONS
Semaglutide was associated with significant weight reduction in obese patients with heart failure, accompanied by improved NYHA classification and 6-minute walk distance. Larger, multi-center trials and prospective, randomized controlled trials are warranted. These studies should focus on assessing long-term outcomes, optimizing dosage, and exploring the potential cardiovascular benefits beyond weight reduction.
Identifiants
pubmed: 39462311
doi: 10.1186/s12872-024-04275-2
pii: 10.1186/s12872-024-04275-2
doi:
Substances chimiques
semaglutide
53AXN4NNHX
Glucagon-Like Peptides
62340-29-8
Glucagon-Like Peptide-1 Receptor
0
GLP1R protein, human
0
Anti-Obesity Agents
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
590Informations de copyright
© 2024. The Author(s).
Références
Mozaffarian D, Benjamin EJ, Go AS, et al. Heart disease and stroke statistics–2015 update: a report from the American Heart Association. Circulation. 2015;131(4):e29–322. https://doi.org/10.1161/CIR.0000000000000152 .
doi: 10.1161/CIR.0000000000000152
pubmed: 25520374
Joyce E, Lala A, Stevens SR, et al. Prevalence, Profile, and prognosis of severe obesity in contemporary hospitalized heart failure trial populations. JACC Heart Fail. 2016;4(12):923–31. https://doi.org/10.1016/j.jchf.2016.09.013 .
doi: 10.1016/j.jchf.2016.09.013
pubmed: 27908391
pmcid: 6693578
Horwich TB, Broderick S, Chen L, et al. Relation among body mass index, exercise training, and outcomes in chronic systolic heart failure. Am J Cardiol. 2011;108(12):1754–9. https://doi.org/10.1016/j.amjcard.2011.07.051 .
doi: 10.1016/j.amjcard.2011.07.051
pubmed: 21907317
pmcid: 3229667
Tsujimoto T, Kajio H. Abdominal obesity is Associated with an increased risk of all-cause mortality in patients with HFpEF. J Am Coll Cardiol. 2017;70(22):2739–49. https://doi.org/10.1016/j.jacc.2017.09.1111 .
doi: 10.1016/j.jacc.2017.09.1111
pubmed: 29191321
Csige I, Ujvárosy D, Szabó Z, et al. The impact of obesity on the Cardiovascular System. J Diabetes Res. 2018;2018:3407306. https://doi.org/10.1155/2018/3407306 .
doi: 10.1155/2018/3407306
pubmed: 30525052
pmcid: 6247580
Powell-Wiley TM, Poirier P, Burke LE, et al. Obesity and Cardiovascular Disease: A Scientific Statement from the American Heart Association. Circulation. 2021;143(21):e984–1010. https://doi.org/10.1161/CIR.0000000000000973 .
doi: 10.1161/CIR.0000000000000973
pubmed: 33882682
pmcid: 8493650
de Bacquer D, Jennings CS, Mirrakhimov E, et al. Potential for optimizing management of obesity in the secondary prevention of coronary heart disease. Eur Heart J Qual Care Clin Outcomes. 2021. https://doi.org/10.1093/ehjqcco/qcab043 .
doi: 10.1093/ehjqcco/qcab043
Samson WK, Yosten GLC, Remme CA. A primer on obesity-related cardiomyopathy. Physiol Rev. 2022;102(1):1–6. https://doi.org/10.1152/physrev.00023.2021 .
doi: 10.1152/physrev.00023.2021
pubmed: 34396793
Kitzman DW, Brubaker P, Morgan T, et al. Effect of Caloric Restriction or Aerobic Exercise Training on Peak Oxygen Consumption and Quality of Life in obese older patients with heart failure with preserved ejection fraction: a Randomized Clinical Trial. JAMA. 2016;315(1):36–46. https://doi.org/10.1001/jama.2015.17346 .
doi: 10.1001/jama.2015.17346
pubmed: 26746456
pmcid: 4787295
Sorli C, Harashima S, Tsoukas GM, et al. Efficacy and safety of once-weekly semaglutide monotherapy versus placebo in patients with type 2 diabetes (SUSTAIN 1): a double-blind, randomised, placebo-controlled, parallel-group, multinational, multicentre phase 3a trial. Lancet Diabetes Endocrinol. 2017;5(4):251–60. https://doi.org/10.1016/S2213-8587(17)30013-X .
doi: 10.1016/S2213-8587(17)30013-X
pubmed: 28110911
Wilding JPH, Batterham RL, Calanna S, et al. Once-weekly semaglutide in adults with overweight or obesity. N Engl J Med. 2021;384(11):989. https://doi.org/10.1056/NEJMoa2032183 .
doi: 10.1056/NEJMoa2032183
pubmed: 33567185
Margulies KB, Hernandez AF, Redfield MM, et al. Effects of Liraglutide on Clinical Stability among patients with Advanced Heart failure and reduced ejection fraction: a Randomized Clinical Trial. JAMA. 2016;316(5):500–8. https://doi.org/10.1001/jama.2016.10260 .
doi: 10.1001/jama.2016.10260
pubmed: 27483064
pmcid: 5021525
Jorsal A, Kistorp C, Holmager P, et al. Effect of liraglutide, a glucagon-like peptide-1 analogue, on left ventricular function in stable chronic heart failure patients with and without diabetes (LIVE)-a multicentre, double-blind, randomised, placebo-controlled trial. Eur J Heart Fail. 2017;19(1):69–77. https://doi.org/10.1002/ejhf.657 .
doi: 10.1002/ejhf.657
pubmed: 27790809
Deanfield J, Verma S, Scirica BM, et al. Semaglutide and cardiovascular outcomes in patients with obesity and prevalent heart failure: a prespecified analysis of the SELECT trial. Lancet. 2024;404(10454):773–86. https://doi.org/10.1016/S0140-6736(24)01498-3 .
doi: 10.1016/S0140-6736(24)01498-3
pubmed: 39181597
Butler J, Shah SJ, Petrie MC, et al. Semaglutide versus placebo in people with obesity-related heart failure with preserved ejection fraction: a pooled analysis of the STEP-HFpEF and STEP-HFpEF DM randomised trials. Lancet. 2024;403(10437):1635–48. https://doi.org/10.1016/S0140-6736(24)00469-0 .
doi: 10.1016/S0140-6736(24)00469-0
pubmed: 38599221
pmcid: 11317105
McDonagh TA, Metra M, Adamo M, et al. 2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021;42(36):3599–726. https://doi.org/10.1093/eurheartj/ehab368 .
doi: 10.1093/eurheartj/ehab368
pubmed: 34447992
Padwal R, McAlister FA, McMurray JJV, et al. The obesity paradox in heart failure patients with preserved versus reduced ejection fraction: a meta-analysis of individual patient data. Int J Obes (Lond). 2014;38(8):1110–4. https://doi.org/10.1038/ijo.2013.203 .
doi: 10.1038/ijo.2013.203
pubmed: 24173404
de Schutter A, Lavie CJ, Kachur S, Patel DA, Milani RV. Body composition and mortality in a large cohort with preserved ejection fraction: untangling the obesity paradox. Mayo Clin Proc. 2014;89(8):1072–9. https://doi.org/10.1016/j.mayocp.2014.04.025 .
doi: 10.1016/j.mayocp.2014.04.025
pubmed: 25039037
Freeman LM. The pathophysiology of cardiac cachexia. Curr Opin Support Palliat Care. 2009;3(4):276–81. https://doi.org/10.1097/SPC.0b013e32833237f1 .
doi: 10.1097/SPC.0b013e32833237f1
pubmed: 19797959
Lena A, Ebner N, Anker MS. Cardiac cachexia. Eur Heart J Suppl. 2019;21(Suppl L):L24–7. https://doi.org/10.1093/eurheartj/suz241 .
doi: 10.1093/eurheartj/suz241
pubmed: 31885509
pmcid: 6926416
Levitan EB, Yang AZ, Wolk A, Mittleman MA. Adiposity and incidence of heart failure hospitalization and mortality: a population-based prospective study. Circ Heart Fail. 2009;2(3):202–8. https://doi.org/10.1161/CIRCHEARTFAILURE.108.794099 .
doi: 10.1161/CIRCHEARTFAILURE.108.794099
pubmed: 19808341
pmcid: 2732194
Haykowsky MJ, Kouba EJ, Brubaker PH, Nicklas BJ, Eggebeen J, Kitzman DW. Skeletal muscle composition and its relation to exercise intolerance in older patients with heart failure and preserved ejection fraction. Am J Cardiol. 2014;113(7):1211–6. https://doi.org/10.1016/j.amjcard.2013.12.031 .
doi: 10.1016/j.amjcard.2013.12.031
pubmed: 24507172
pmcid: 4282135
Romeiro FG, Okoshi K, Zornoff LAM, Okoshi MP. Gastrointestinal changes associated to heart failure. Arq Bras Cardiol. 2012;98(3):273–7.
pubmed: 22527026
Petrie MC, Borlaug BA, Butler J, et al. Semaglutide and NT-proBNP in obesity-related HFpEF: insights from the STEP-HFpEF program. J Am Coll Cardiol. 2024;84(1):27–40. https://doi.org/10.1016/j.jacc.2024.04.022 .
doi: 10.1016/j.jacc.2024.04.022
pubmed: 38819334
Schou M, Petrie MC, Borlaug BA, et al. Semaglutide and NYHA Functional Class in obesity-related heart failure with preserved ejection fraction: the STEP-HFpEF program. J Am Coll Cardiol. 2024;84(3):247–57. https://doi.org/10.1016/j.jacc.2024.04.038 .
doi: 10.1016/j.jacc.2024.04.038
pubmed: 38913004
Saraceni C, Broderick TL. Effects of glucagon-like peptide-1 and long-acting analogues on cardiovascular and metabolic function. Drugs R D. 2007;8(3):145–53. https://doi.org/10.2165/00126839-200708030-00002 .
doi: 10.2165/00126839-200708030-00002
pubmed: 17472410
Goldney J, Sargeant JA, Davies MJ. Incretins and microvascular complications of diabetes: neuropathy, nephropathy, retinopathy and microangiopathy. Diabetologia. 2023;66(10):1832–45. https://doi.org/10.1007/s00125-023-05988-3 .
doi: 10.1007/s00125-023-05988-3
pubmed: 37597048
pmcid: 10474214
Withaar C, Meems LMG, Nollet EE, et al. The cardioprotective effects of Semaglutide Exceed those of Dietary Weight loss in mice with HFpEF. JACC Basic Transl Sci. 2023;8(10):1298–314. https://doi.org/10.1016/j.jacbts.2023.05.012 .
doi: 10.1016/j.jacbts.2023.05.012
pubmed: 38094687
pmcid: 10714176
Verreth W, de Keyzer D, Pelat M, et al. Weight-loss-associated induction of peroxisome proliferator-activated receptor-alpha and peroxisome proliferator-activated receptor-gamma correlate with reduced atherosclerosis and improved cardiovascular function in obese insulin-resistant mice. Circulation. 2004;110(20):3259–69. https://doi.org/10.1161/01.CIR.0000147614.85888.7A .
doi: 10.1161/01.CIR.0000147614.85888.7A
pubmed: 15533870
Mahajan R, Stokes M, Elliott A, et al. Complex interaction of obesity, intentional weight loss and heart failure: a systematic review and meta-analysis. Heart. 2020;106(1):58–68. https://doi.org/10.1136/heartjnl-2019-314770 .
doi: 10.1136/heartjnl-2019-314770
pubmed: 31530572
Packer M, Anker SD, Butler J, et al. Cardiovascular and renal outcomes with Empagliflozin in Heart failure. N Engl J Med. 2020;383(15):1413–24. https://doi.org/10.1056/NEJMoa2022190 .
doi: 10.1056/NEJMoa2022190
pubmed: 32865377
Anker SD, Butler J, Filippatos G, et al. Empagliflozin in Heart failure with a preserved ejection fraction. N Engl J Med. 2021;385(16):1451–61. https://doi.org/10.1056/NEJMoa2107038 .
doi: 10.1056/NEJMoa2107038
pubmed: 34449189
Kosiborod MN, Deanfield J, Pratley R, et al. Semaglutide versus placebo in patients with heart failure and mildly reduced or preserved ejection fraction: a pooled analysis of the SELECT, FLOW, STEP-HFpEF, and STEP-HFpEF DM randomised trials. Lancet. 2024;404(10456):949–61. https://doi.org/10.1016/S0140-6736(24)01643-X .
doi: 10.1016/S0140-6736(24)01643-X
pubmed: 39222642