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Atrial Fibrillation and Semaglutide Effects in Obesity-Related Heart Failure With Preserved Ejection Fraction:
Subodh Verma1, Javed Butler2, Barry A Borlaug3
1Division of Cardiac Surgery, Li Ka Shing Knowledge Institute of St Michael's Hospital, Unity Health Toronto, University of Toronto, Toronto, Ontario, Canada.
Journal of the American College of Cardiology
|September 1, 2024
Summary
Semaglutide significantly improved heart failure symptoms and physical limitations in patients with obesity-related heart failure with preserved ejection fraction (HFpEF), with greater benefits observed in those with atrial fibrillation (AF). The drug also reduced body weight and key biomarkers.
Area of Science:
- Cardiology
- Metabolic Diseases
- Pharmacology
Background:
- Obesity is a significant risk factor for both heart failure with preserved ejection fraction (HFpEF) and atrial fibrillation (AF).
- The STEP-HFpEF program demonstrated semaglutide's efficacy in improving HFpEF symptoms and reducing weight in obese patients.
- The impact of semaglutide on HFpEF patients with varying AF statuses requires further investigation.
Purpose of the Study:
- To characterize baseline differences between HFpEF patients with and without a history of AF.
- To assess whether semaglutide's effectiveness in the STEP-HFpEF program is influenced by the presence or type of AF.
Main Methods:
- A secondary analysis of pooled data from the STEP-HFpEF and STEP-HFpEF DM trials.
- 1145 patients with obesity-related HFpEF received either semaglutide 2.4 mg or placebo for 52 weeks.
- Efficacy was evaluated based on changes in KCCQ-CSS, body weight, 6-minute walk distance, composite endpoints, CRP, and NT-proBNP, stratified by AF history.
Main Results:
- 45% of participants had a history of AF, presenting with older age, higher NT-proBNP, and more advanced HF symptoms.
- Semaglutide demonstrated significantly greater improvements in KCCQ-CSS and the hierarchical composite endpoint in patients with AF compared to those without.
- Semaglutide consistently reduced body weight, CRP, and NT-proBNP across all subgroups, irrespective of AF status.
Conclusions:
- Atrial fibrillation is common in obesity-related HFpEF and associated with more severe disease characteristics.
- Semaglutide offers significant benefits for HFpEF symptoms, physical function, and biomarkers in patients with or without AF.
- The therapeutic benefits of semaglutide on HF symptoms and limitations were more pronounced in patients with a history of AF.
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