Glucagon-like peptide-1 (GLP-1) receptor agonists have been widely touted for weight loss. New data from the STEP-HFpEF and STEP-HFpEF-DM trials to be presented at the 84^th Scientific Sessions confirm the agents can have similarly important benefits for heart failure, including in individuals who have both heart failure and diabetes.

“Overweight and obesity have been for many years considered to be comorbidities in people who have heart failure with preserved ejection fraction (HFpEF),” said Subodh Verma, MD, PhD, FRCSC, Cardiac Surgeon at St. Michael’s Hospital, Toronto, Canada, and Professor and Canada Research Chair in Cardiovascular Surgery at the University of Toronto. “There has been a lot of discussion around whether weight is a bystander versus a causal factor in the genesis of HFpEF. This is the first attempt to see if lowering weight would actually result in an improvement in patient-reported symptoms of heart failure, physical function, exercise, capacity, etc., in people with HFpEF. This is a very important advance, conceptually, that points to how obesity is not just a comorbidity in people with HFpEF but is a target for treatment.”

Dr. Verma will discuss the clinical implications of The STEP-HFpEF and STEP-HFpEF-DM Trials—Targeting Obesity to Treat Heart Failure on Sunday, June 23, from 4:30 p.m. – 6:00 p.m. ET in Room W320, the Chapin Theater, of the Orange County Convention Center. The symposium also will be livestreamed on the virtual meeting platform for registered meeting participants and will be available on-demand following the 84^th Scientific Sessions.

Mikhail N. Kosiborod, MD, Saint Luke’s Mid America Heart Institute, will review top line results of the Semaglutide Treatment Effect in People with Obesity and Heart Failure with Preserved Ejection Fraction and Diabetes Mellitus Trial (STEP-HFpEF-DM). The study showed dramatic improvements in quality of life, body weight, A1C, time to first heart failure event, and other key endpoints.

Melanie J. Davies, CBE, MB, ChB, MD, FRCP, FRCGP, FMedSci, Diabetes Research Centre, University of Leicester, United Kingdom, will discuss the metabolic outcomes of STEP-HFpEF-DM, including new insight into the effect of sodium-glucose cotransporter-2 (SGLT2) inhibitor use in people with both diabetes and HFpEF. 

“Heart failure, particularly HFpEF, can be a difficult diagnosis to make,” Dr. Verma noted. “Raising awareness around HFpEF among diabetes specialists is important. We have been thinking about GLP-1 receptor agonists in terms of weight reduction, but when it comes to diabetes, it is important to think about three factors: the pipe, the pump, and the filter, i.e., atherosclerosis benefit, heart failure benefit, and renal protection.

“We know that GLP-1 receptor agonists are anti-atherosclerotic, they improve the pipe and improve atherosclerotic outcomes,” he continued. “And we already have data to confirm renal protection, improving the filter. This trial shows GLP-1s are also efficacious for pump-related outcomes, for HFpEF. That is an enormous benefit.”

GLP-1 receptor agonists can now be considered as a combination therapy with SGLT2 inhibitors in people with HFpEF, Dr. Verma added. This is the first good treatment option for people with diabetes, overweight or obesity, and HFpEF.

“Clinicians should be looking out for HFpEF in patients who have diabetes or overweight or obesity, or who have both,” Dr. Verma said. “We should all be reassured that the benefits of using GLP-1 receptor agonists in these patients are not just weight reduction. There are also benefits to the myocardium and improvements in patient-reported outcomes of heart failure. We all know how efficacious semaglutide can be for weight reduction. Let’s not forget how formidable it is for heart protection, vascular protection, and patient protection.”