Sanjiv Shah, MD, Neil J. Stone, MD, Professor of Cardiology, has been involved in clinical trials investigating a specific type of heart failure called heart failure with preserved ejection fraction (HFpEF). He was a co-author of the study published in. Circulation We found that once-weekly administration of semaglutide improved health outcomes and quality of life in patients with obesity and HFpEF.

Cardiac imaging tests show that patients with HFpEF have hardening of the heart muscle and fluid buildup in the lungs and body. In this study, more than 500 participants with obesity and HFpEF were randomly assigned to receive weekly semaglutide (2.4 milligrams) or a placebo for one year.

“We know that obesity is associated with the prevalence of HPpEF,” Shah said.

Of the estimated 5 million people diagnosed with heart failure each year in the United States, nearly half develop HFpEF.

In this study, participants on semaglutide experienced greater weight loss and greater improvements in heart failure-related symptoms, physical limitations, and motor function, regardless of baseline health status, including overall symptoms and quality of life. Researchers found that the experience. Semaglutide was also associated with improvements in all domains of the Kansas City Cardiomyopathy Questionnaire, a health status measure that combines patients’ quality of life and symptoms.

Another study published in New England Medical Journal, The study, co-authored by Shah, found that participants who took semaglutide lost more weight, with an average weight loss of 13.3%, compared to 2.6% for patients who took a placebo. is said to have been shown.

At the end of the study, patients who received semaglutide were able to walk farther and had lower levels of C-reactive protein, a biomarker of inflammation known to cause heart failure, than those who received a placebo. Ta. Importantly, patients receiving semaglutide also had greater reductions in B-type natriuretic peptide, a biomarker that correlates with heart failure severity, compared to placebo.

“It was really surprising how effective it was as a weight loss drug, even in the setting of heart failure,” Shah said. “But what we were most interested in was whether the drug could reduce the symptoms and signs of heart failure itself. We found that patients treated with semaglutide (compared to placebo) could reduce the symptoms and signs of heart failure itself. We found that health status (including quality of life, symptoms, and physical limitations) improved significantly. In fact, semaglutide improved health status more than any other heart failure treatment tested to date. I did. [All of this] “We hope to convince the scientific community that obesity causes this syndrome,” Shah said.

Shah said combination therapies and other drugs are also being tested that could make a big difference for these patients.

“Semaglutide is just the tip of the iceberg,” Shah said.

Identifying health equity challenges

With any new treatment, many questions swirl around its implementation and access. Who has access to the drug and who does not? What are the economic and living costs?

Clyde Yancey, MD, MS, professor of cardiology, said these new drugs to treat obesity allow us to think about obesity differently. “[Obesity] It should be treated as a disease and these drugs allow us to remove the stigma. Obesity should not be a derogatory term; it is a medical condition, just like high blood pressure or diabetes. ”

Still, Yancey says the participant cohorts in these trials lack racial diversity. This lack of diversity may make it difficult to convincingly demonstrate that semaglutide and other GLP-1 receptor agonists are effective in different populations, and may result in underrepresentation in important studies. It will be even more difficult to introduce this therapy to small populations.

Veronica Johnson, MD, is an assistant professor of medicine who treats patients in the Center for Lifestyle Medicine. She entered the world of obesity medicine from internal medicine after noticing that there were few Black women physicians treating obesity in the field.

Johnson said it is important to raise awareness about barriers to accessing these medications, such as insurance, lack of education of health care providers about obesity treatment, stigma, race, and other issues.

Although there has been a lot of talk in the media about the cosmetic use of these drugs, Johnson said it is not safe. “There is no data to show that it is safe to use for cosmetic purposes.”

Johnson is natural medicine, outlines the inequalities faced by patients and healthcare providers around GLP-1 receptor agonists. Lack of insurance coverage, cost, stigma and regulation are some of the key factors she discussed.

Johnson and colleagues say semaglutide and similar drugs have great potential to be effective, but access barriers make it difficult. More research is needed to understand long-term use and “how the weight stigma and stigma experienced in society may be hindering uptake of these treatments,” Johnson said. .

“We know from bariatric surgery research that Black and Latino patients have poorer outcomes after surgery for a variety of reasons. We need more clinical trials with diverse populations and samples.”

Melissa Rohman and Olivia Dimmer contributed to this story.

This is part of a two-part series. Last month, we covered anti-obesity drugs being used to treat obesity and the advocacy work being done to improve patient access.please read the story here.