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Obesity and Weight Loss Strategies for Patients With Heart Failure
Amanda R Vest1, Philip R Schauer2, Jo E Rodgers3
1Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Kaufman Center for Heart Failure Treatment and Recovery, Cleveland Clinic, Cleveland, Ohio, USA.
JACC. Heart Failure
|August 2, 2024
Summary
Obesity is common in heart failure patients. New weight loss medications like GLP-1 agonists show promise for heart failure with preserved ejection fraction (HFpEF), improving safety and efficacy.
Area of Science:
- Cardiology
- Endocrinology
- Metabolic Diseases
Background:
- Obesity is a frequent comorbidity in heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF).
- The pathophysiologic link between obesity and HFpEF is particularly strong.
- Current lifestyle interventions for weight loss in heart failure patients face sustainability challenges and have limited efficacy data.
Purpose of the Study:
- To evaluate the role of bariatric surgery and antiobesity medications in managing obesity in heart failure patients.
- To assess the safety and efficacy of newer antiobesity medications, specifically GLP-1 agonists, in the context of heart failure.
Main Methods:
- Review of existing data on bariatric surgery in patients with preoperative heart failure or left ventricular dysfunction.
- Analysis of safety and efficacy data from general population trials of GLP-1 and gastric inhibitory polypeptide/GLP-1 agonists.
- Examination of trials involving the GLP-1 agonist semaglutide for obesity treatment in patients with HFpEF.
Main Results:
- Bariatric surgery demonstrates moderate efficacy and safety, with associations to reduced heart failure hospitalizations and medium-term mortality.
- Antiobesity medications, particularly GLP-1 agonists, show encouraging safety and weight loss efficacy.
- Semaglutide trials confirm safety and efficacy in patients with HFpEF, despite some concerns in advanced HFrEF.
Conclusions:
- While bariatric surgery offers benefits, newer antiobesity medications like GLP-1 agonists present a promising therapeutic avenue for obesity in heart failure.
- GLP-1 agonists, especially semaglutide, are safe and effective for managing obesity in HFpEF patients.
- Further research is warranted to fully understand the long-term cardiovascular implications and optimal use of these agents across the heart failure spectrum.
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