May 2024

CARDIOVASCULAR

WEIGHT LOSS DRUG SHOWS BENEFITS FOR HEART FAILURE

Featuring: Sanjiv Shah, ’00 MD​
The drug semaglutide, sold under brand names Ozempic and Wegovy, can help reduce heart failure symptoms and reduce heart failure hospitalizations in patients with obesity, according to a pair of studies published in The Lancet and The New England Journal of Medicine.

The studies, which provide new results from two clinical trials, compared the effects of semaglutide versus placebo in reducing heart failure-related symptoms, physical limitations, weight and heart failure hospitalizations in patients with obesity and heart failure with preserved ejection fraction, or HFpEF.

HFpEF, which stiffens the heart muscle and stops it from filling with blood properly, affects more than half of patients with heart failure and has limited treatment options, according to Sanjiv Shah, ’00 MD, the Neil J. Stone, MD, Professor of Medicine in the Division of Cardiology, and a co-author of the studies.

​Study participants who had obesity, HFpEF, and diabetes who received semaglutide lost more than double the weight of participants on placebo, were able to walk farther during a timed test, and saw a drop in heart failure and inflammation-related biomarkers, according to the trial published in The New England Journal of Medicine, which included more than 600 participants.

“The clinical trial of semaglutide in patients with obesity-related HFpEF and diabetes added to a trial we published last year in patients with obesity-related HFpEF without diabetes. What we found in both trials was an improvement in the quality of life and a reduction in physical limitations in patients treated with semaglutide,” Shah said. “We saw an improvement in their six-minute walk distance, as well as a reduction in NT-proBNP, which is a biomarker of congestion, and a reduction in C-reactive protein, a marker of inflammation.”

The results of the two trials were combined in the study published in The Lancet, which tracked more than 1,000 participants over a year.

Patients taking semaglutide also had fewer heart failure events and were hospitalized less often, compared to those on placebo, according to the trials.

​“In our pooled analysis, we found heart failure hospitalizations went down by 70 percent, which is unheard of with a medication for heart failure,” Shah said. “The drug is causing dramatic weight loss, but it’s also preventing patients from being hospitalized for heart failure. Once patients with HFpEF are hospitalized for heart failure, their five-year mortality can be as high as 65 percent.”

While there’s now robust evidence that people with HFpEF and obesity can benefit from semaglutide, the expense of the drug can often be a barrier, Shah said.

“I hope insurance companies can do a risk-based approval,” Shah said. “Patients with heart failure are at the highest risk for hospitalizations, death and bad outcomes, and are the ones that need to be prioritized in terms of coverage.”

In the future, Shah said he hopes semaglutide can become available for patients who may not meet the criteria for obesity, but have a high amount of “bad” visceral fat, which can lead to a host of poor health outcomes.

“This is just the tip of the iceberg — there are a lot of additional anti-obesity drugs in development with different mechanisms of action,” Shah said. “My hope is that there will be even more options to treat this and reduce the burden of disease.”

The trials were funded by Novo Nordisk, which manufactures semaglutide.

This article was originally published in the Northwestern University Feinberg School of Medicine News Center on May 8, 2024. 
Sanjiv Shah, ’00 MD, the Neil J. Stone, MD, Professor of Medicine in the Division of Cardiology, was a co-author of the studies published in The Lancet and The New England Journal of Medicine.  
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