HFpEF: Actually Treating Obesity Makes the Difference

Portrait of Nikolay ChichagovOn Friday, NEJM published impressive results in an RCT of semaglutide for treating patients who have obesity and heart failure with preserved ejection fraction (HFpEF). The treatment enabled these people to function better, feel better, and suffer half as many serious adverse events. These are important benefits for people with a very difficult condition.

But the story does not end there. Just yesterday, Nature Medicine published an important prespecified analysis from this study to explain how this treatment strategy works so well. The finding is that actually treating obesity – rather than merely telling a patient to lose weight – makes a big difference in clinical outcomes for HFpEF.

The implication is that obesity itself makes a big contribution to this increasingly common type of heart failure.

Less Obesity Equals
Less Heart Failure Symptoms

The prespecified analysis for this publication had the specific intent to evaluate the relationship between reduction of obesity in these patients and the reduction in their symptoms of heart failure. These patients on semaglutide lost an average of 13% of their starting body weight in the 52 weeks of this study. In the control group, they lost less than three percent.

The findings of this analysis were quite straightforward:

“Greater body weight reduction with semaglutide was associated with greater improvements in HF symptoms and physical limitations assessed by the KCCQ-CSS, exercise function assessed by the six-minute walk distance, and greater reduction in systemic inflammation assessed by C-reactive protein levels”

Current Practice:
Instruct the Patient to Lose Weight

The control Group in this study received the current standard of care for HFpEF. That means an SGLT-2 inhibitor, diuretics, hypertension treatment, and self care. The self care is all about diet and exercise – instructing the patient to lose weight and maintain aerobic fitness as best they can. Nothing more for obesity treatment.

So it is little wonder that patients in the control arm did not see big improvements in their obesity. DIY obesity treatment has serious limitations.

This analysis offers us important learning. Obesity plays an important role in the pathology of HFpEF and thus, actually treating obesity with the best available tools might significantly improve the health of these patients. Instructing them to lose weight is a lame alternative.

Click here for the new analysis in Nature Medicine and here for more on the NEJM publication. For further perspective on DIY obesity treatment, click here.

Portrait of Nikolay Chichagov, painting by Konstantin Korovin / WikiArt

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August 28, 2023