Drs Piña and Kosiborod discuss semaglutide in obesity-related HF with and without diabetes. Both STEP HFpEF trials show similar HF benefits despite less weight loss in patients with diabetes.
Professor of Medicine/Cardiology/ Heart Failure /Transplant; Quality Officer, Cardiovascular Line, Sidney Kimmel College of Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania; Clinical Professor of Medicine, Central Michigan University College of Medicine, Mount Pleasant, Michigan; Adjunct Professor of Epidemiology and Biostatistics, Population & Quantitative Health Sciences, Case Western University, Cleveland, OhioServe as a director, office, partner, employee, advisor,...
The crux of the hypothesis behind the program is that we all know the prevalence of HFpEF has increased dramatically in the past couple of decades. When I was a fellow in training, it was rare for me to see a patient with HF who had preserved EF. A majority of patients had HF with reduced EF. Now, the majority of people we see have HFpEF: Why did that happen? There are a lot of different reasons for the dramatic change in epidemiology.
We knew from the beginning that the weight loss likely was going to be different. Then, of course, there are other things that happen in people with diabetes: They have more severe HFpEF phenotype, and people with more severe disease sometimes don't respond to treatment the same way as those with less severe disease.
The largest improvement was in the symptom burden and symptom frequency. It was more than a 10-point average. Now, to your point about whether people just feel lighter. Is it what we sometimes call mechanical unloading through weight loss and not really a pathobiology benefit on the disease modification for HF. As I mentioned, we just presented a combined paper published in
Don't get me wrong. Those with less severe HF still got a very large benefit. This is not an interaction in terms of severity of HFpEF. Everybody benefits, and everybody has a large benefit. But it was that the benefits were even more pronounced in people with more severe HF, so the interaction was in the magnitude of improvement.
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