Tirzepatide Cuts Adverse Heart Failure Outcomes by 38%

One more chapter opened this week in the ongoing story of diseases that improve when healthcare providers effectively treat obesity. Lilly announced topline results from a study showing that tirzepatide cuts the rate of adverse heart failure outcomes in persons with obesity and heart failure by 38% when compared to placebo. The specific form of heart failure in this study is HFpEF – heart failure with preserved ejection fraction.

Jeff Emmick, MD, PhD, is senior vice president for product development at Lilly. He explained the significance of this finding:

“HFpEF accounts for nearly half of all heart failure cases, and in the U.S. almost 60% of those impacted also live with obesity. Despite a continuing increase in the number of people with both HFpEF and obesity, treatment options remain limited. Previous incretin studies in this population focused on symptoms and physical limitations. In a first-of-its-kind trial, tirzepatide reduced severity of symptoms and improved heart failure outcomes in people with HFpEF and obesity.”

Two Primary Outcomes

This study had two primary outcome objectives. Both were met. The first, a reduction in adverse heart failure outcomes is generating the excitement. This endpoint is a composite of the time to first occurrence of an urgent heart failure visit, heart failure hospitalization, oral diuretic intensification, or cardiovascular death. The study followed up 731 participants randomized to drug or placebo for a median of 104 weeks on this endpoint.

The other primary endpoint was change in the Kansas City Cardiomyopathy Questionnaire Clinical Summary Score (KCCQ-CSS) from baseline to week 52. The KCCQ-CSS is a patient-reported measure of symptoms and physical limitations associated with heart failure.

Study results also met objectives for a range of secondary outcomes. These included exercise capacity, inflammation, and body weight reduction from baseline at 52 weeks. The efficacy estimand for weight loss with tirzepatide was 15.7% versus 2.2% for placebo.

Catch-Up?

Lilly has a very effective dual agonist product for obesity in tirzepatide. It is a couple of years behind Novo Nordisk with a cardiovascular outcomes indication, though. This study may provide them a somewhat narrower indication than the one that FDA approved for semaglutide in obesity and heart disease.

So it may help while the company waits for outcomes from the SURMOUNT-MMO trial, which aims for a much broader indication to reduce morbidity and mortality from obesity. That will take another three years and may mark yet another big milestone in understanding the health benefits of treating obesity.

These are exciting times for advances in obesity care.

Click here for the details from Lilly, here, here, and here for further reporting.

Failed Pump, Carthage, MO, photograph by Ted Kyle / ConscienHealth

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August 3, 2024