Dr. Javed Butler and Dr. Mikhail Kosiborod explore the “obesity paradox” in heart failure (HF), where higher body mass index in patients with HF, particularly with reduced ejection fraction, correlates with better survival rates. This paradox is linked to the distinction between intentional and unintentional weight loss, with the latter signaling disease progression and worse outcomes. They emphasize that visceral adiposity worsens HF symptoms, physical limitations, and quality of life, especially in preserved ejection fraction HF (HFpEF), through mechanisms like increased plasma volume, pulmonary hypertension, and metabolic dysfunction.

The STEP-HFpEF trial, led by Dr. Kosiborod, assessed semaglutide, a GLP-1 receptor agonist, in obesity-related HFpEF, showing significant improvements in symptoms, physical function, weight loss, and reduced inflammation. These results highlight semaglutide’s potential to address HFpEF’s root causes. A separate trial is underway for HFpEF patients with type 2 diabetes, who face more severe disease and unique challenges. These studies signal promising advancements in treating HFpEF, particularly for patients with obesity and diabetes.

Reference: Butler J, Kosiborod, M. Targeting Obesity to Improve HFpEF Outcomes. Medscape. Published May 10, 2024. Accessed November 6, 2024. https://www.medscape.com/viewarticle/1000202?src=dpcs&form=fpf