Patients With Heart Failure May Benefit From Weight Loss Drug

Weight loss drug semaglutide may help prevent heart attacks and other major adverse cardiac events (MACE) among people classified as overweight who also have cardiovascular disease, regardless if they also have heart failure, according to new research published in The Lancet.¹

In a recent analysis from 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 lowered the risk of MACE and heart failure in patients with atherosclerotic cardiovascular disease and overweight or obesity, regardless of heart failure presence or type. The overall study included more than 17,600 participants, with about a quarter having a history of heart failure, and all patients were 45 years and older with a body mass index (BMI) of at least 27 kg/m² or greater and established cardiovascular disease. Patients were randomized to receive semaglutide 2.4 mg or placebo.

The GLP-1 receptor agonist was effective for both types of heart failure | Image credit: Ole – stock.adobe.com

Focusing on the 4286 patients with 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. While baseline characteristics were similar between patients with and without heart failure, those with heart failure had a higher incidence of clinical events.

After taking semaglutide, patients with heart failure had a 28% lower risk of MACE compared with those without heart failure, including a 21% reduced risk of the heart failure composite end point of cardiovascular death, cardiovascular hospitalization, or urgent hospital visit for heart failure. Additionally, the risk of cardiovascular death alone was reduced by 24% and the risk of all-cause death was reduced by 19% in comparison.

The GLP-1 receptor agonist was effective for both types of heart failure. For patients with HFrEF, the risk of MACE decreased by 35%, while it dropped by 31% for those with HFpEF. Despite this, patients with HFrEF experienced more heart-related events overall compared with patients with HFpEF. Additionally, the risk of composite heart failure events was reduced by 21% in the HFrEF group and by 25% in the HFpEF group.

Notably, the benefits of semaglutide were consistent regardless of patient factors like age, gender, BMI, heart failure severity, and diuretic use. Patients taking semaglutide also experienced fewer serious adverse events compared with those on placebo regardless of their heart failure type.

These results align with earlier research by the same team, which found that weekly semaglutide injections led to a 20% decrease in MACE, such as heart attacks and strokes, in individuals with obesity or overweight who also had cardiovascular disease.² Patients with obesity face a heightened risk of cardiovascular issues and heart failure, which has often been underestimated, and the prognosis of patients with HFrEF is worse when they also have obesity.¹ This analysis of the SELECT trial found that semaglutide significantly benefits patients with atherosclerotic cardiovascular disease and overweight or obesity, regardless of their heart failure status.

“The benefit we observed from semaglutide was seen in addition to usual care recommendations during the period of the trial and could represent a new clinical opportunity,” the researchers notes. “In many countries, patients with clinical atherosclerotic cardiovascular disease often have either overweight or obesity, and the incidence is increasing.”

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

“We showed, for the first time to our knowledge, that patients with atherosclerotic cardiovascular disease, overweight or obesity, and heart failure with reduced ejection fraction (who had a greatest absolute risk) had significant reductions in MACE with semaglutide, and the treatment effect on the heart failure composite was observed to be similar to that seen in the population with heart failure with preserved ejection fraction,” the researchers said. “This finding contrasts with previous smaller studies, LIVE and FIGHT, involving the GLP-1 receptor agonist liraglutide, which were not limited to patients with obesity and were not adequately powered to assess clinical outcomes.”

References

1. 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. Published online August 24, 2024. doi:10.1016/S0140-6736(24)01498-3

2. Weight loss drug’s heart benefits extend to people with heart failure. News release. University College London. August 22, 2024. Accessed August 23, 2024. https://www.eurekalert.org/news-releases/1055249