Bleeding Heart

Impressive Semaglutide Outcomes in Obesity and Heart Failure

Scientists who study semaglutide in obesity are producing a steady stream of impressive results. Yesterday in the New England Journal of Medicine, a randomized controlled trial in persons with obesity and heart failure with preserved ejection fraction demonstrated superior weight reduction, improvement in heart failure, better physical functioning, and a halving of serious adverse events.

The lead author of this study, Mikhail Kosiborod, explained to NEJM why this study is so impressive:

“Obesity is present in the majority of patients that have this kind of heart failure. They’re very symptomatic. They’re very disabled because of their heart failure symptoms. They have high rates of heart failure hospitalizations and high rates of death. And so they have very bad outcomes, and we have very little to offer them. And this is the first experimental proof that addressing obesity does something incredibly important for this patient population.”

In sum, this is a landmark study demonstrating successful treatment of obesity in a population of patients whose outlook was very grim until now.

Heart Failure with Preserved Ejection Fraction (HFpEF)

HFpEF is a very particular kind of heart failure that occurs when a heart keeps pumping out 50% or more of the blood that fills it with each beat. This is what cardiologists call the heart’s ejection fraction. But in HFpEF, the heart muscle has become stiff and cannot fully relax between beats. So between beats, it doesn’t fill with enough blood to work normally.

This is the specific kind of heart failure tested in the present study. Its prevalence is increasing worldwide as the prevalence of obesity is increasing. Three million people are living with this condition in the U.S. and worldwide, it affects as many as 32 million people. Nearly 80% of persons with HFpEF have overweight or obesity. People with this condition typically wind up in the hospital one or two times a year and 15% of them die each year.

Demonstrating the Importance of Treating Obesity

This study is not just a demonstration of impressive outcomes in treating people with obesity and one particular type of heart failure. It is also an important demonstration of the value of treating obesity to prevent bad outcomes that result when we fail to do so.

Ania Jastreboff, Co-Director of the Yale Center for Weight Management, explains the importance:

“Obesity is associated with 200 other obesity-related diseases. If we treat this one disease, we can potentially improve the health of so many patients in many different ways, and this is yet another important example.”

Treating obesity is costly and hard, but really good options for treating it are here and more are coming. So the treatment is getting easier and the costs will come down. Leaving it untreated is far more costly – to the health and lives of people who have it and to healthcare systems that struggle increasingly with the crushing burden of diseases that result from leaving obesity untreated.

Click here for the new study in NEJM, here for an interview with the lead author, and here for an editorial published with the study. For more about HFpEF, click here and here.

Bleeding Heart, photograph by Ted Kyle / ConscienHealth

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August 26, 2023