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GLP1 receptor agonists in heart failure with preserved pumping function: effects beyond weight loss

Updated

Abstract

More than half of heart failure cases occur with preserved ejection fraction (HFpEF).

  • HFpEF is influenced by comorbidities such as obesity, hypertension, diabetes, and atrial fibrillation.
  • Despite treatments like SGLT2 inhibitors and mineralocorticoid receptor antagonists, morbidity and mortality in HFpEF remain significant.
  • GLP1 receptor agonists, originally for type 2 diabetes, have shown benefits in cardiovascular, renal, and metabolic pathways relevant to HFpEF.
  • Recent trials indicate that semaglutide improves symptoms and functional capacity, while tirzepatide reduces cardiovascular death or worsening heart failure events.
  • Mechanistic evidence points to effects on fluid balance, inflammation, heart structure changes, blood vessel function, and fat tissue quality.

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Full Text

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Funding

Competing interests

Disclosure and potential conflicts of interest: ER declares that they have no conflicts of interest relevant to this manuscript. MCP received honoraria from Alnylam, AstraZeneca and Pfizer. AD received research Support/grants from Abbott, Astra-Zeneca, Bayer, BridgeBio, Merck, NovoNordisk (not related to GLP1), and has been part of a steering comittee for GUIDE-HF (Abbott), HERMES/ATHENA (NovoNordisk), SYMPHONY (AstraZeneca), EASi-HF (Boehringer-Ingelheim) and the National Lead for Merck (VICTOR), PREVENT-HF (AstraZeneca); has received consulting fees from Astra-Zeneca, Bayer, Boehringer-Ingelheim, CSL Behring Canada, GlaxoSmithKline, NovoNordisk and Pfizer; and has received honoraria from Abbott, Astra-Zeneca, Boehringer-Ingelheim, CSL Behring Canada, Lilly, NovoNordisk and Pfizer. The International Committee of Medical Journal Editors (ICMJE) Potential Conflicts of Interests form for the authors is available for download at: https://www.drugsincontext.com/wp-content/uploads/2026/03/dic.2025-12-4-COI.pdf
PubMed

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