Nutrient-Stimulated Hormone Therapies in Heart Failure: Targeting Cardiometabolic Burden Beyond Weight Reduction

The intersection of obesity and heart failure (HF) represents a growing epidemic characterized by a distinct cardiometabolic phenotype. Historically, management has been hamstrung by a significant therapeutic gap: lifestyle interventions often fail to overcome metabolic inertia, yielding negligible weight reduction, while bariatric surgery remains limited by invasiveness. The emergence of Nutrient-Stimulated Hormone (NuSH) therapies, including glucagon-like peptide-1 receptor agonists, has revolutionized this landscape. This review delineates the paradigm shift driven by these agents, which act as a "medical bypass" offering surgical-magnitude weight loss and broad pleiotropic cardioprotection. We analyze pivotal evidence from the STEP-HFpEF and SUMMIT trials, demonstrating that NuSH therapies have established a new standard of care in heart failure with preserved ejection fraction (HFpEF) by not only restoring functional capacity but also significantly reducing hard clinical endpoints. Conversely, we navigate the uncertainty surrounding heart failure with reduced ejection fraction (HFrEF), where historical safety signals regarding chronotropic effects and arrhythmias necessitate a cautious, precision-based approach. Finally, we discuss critical future frontiers, emphasizing the "muscle imperative" to mitigate sarcopenic obesity and the need for biomarker-guided protocols. NuSH therapies have evolved from metabolic tools into essential disease-modifying pillars, necessitating a fundamental recalibration of clinical practice to target the metabolic root of HF.