Defining the Role of Semaglutide in Obese Patients with Heart Failure with Preserved Ejection Fraction

Authors:
Alicia M. Nordberg-Payne, PharmD
Rebecca Munger, PharmD, BCACP
Jason Zupec, PharmD, BCACP

Reviewers:
Robert B. Parker, PharmD
Stuart T Haines, PharmD, BCPS, BCACP

Citation:
Kosiborod MN, Abildstrom SZ, Borlaug BA, et al. Semaglutide in Patients with Heart Failure with Preserved Ejection Fraction and Obesity. N Engl J Med. 2023;389(12):1069-1084.

The Problem

While heart failure with preserved ejection fraction (HFpEF) accounts for at least 50% of all heart failure cases, effective pharmacotherapy to improve outcomes and symptoms remains limited.¹  Over 75% of HFpEF patients have a comorbid diagnosis of obesity.² Obesity is an independent risk factor for the development of HFpEF and contributes to disease progression. Obese patients with HFpEF have greater symptom burden, reduced functional capacity, and impaired quality of life when compared to those without obesity. We know that patients often struggle to adhere to lifestyle modifications long enough to see meaningful weight loss, but one class of medications gaining public popularity due to their ability to produce significant weight loss is the glucagon-like peptide-1 (GLP-1) agonists. While these agents have proven to be remarkably effective weight loss agents, the benefits of GLP-1 agonists for patients with HFpEF who are obese are not yet clear.³