Advances in the management of obesity and heart failure: latest evidence from clinical trials

Feb 25, 2025Current opinion in cardiology

New clinical trial findings on treating obesity and heart failure

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Abstract

Incretin-based therapies may improve quality of life and exercise tolerance while promoting weight loss in patients with obesity-related heart failure with preserved ejection fraction (HFpEF).

Randomized clinical trials indicate that glucagon-like peptide-1 receptor agonists can reduce symptoms and markers of heart failure severity.
Incretin-based treatments may also decrease the risk of heart failure hospitalizations in this patient population.
Exploratory analyses suggest that the mineralocorticoid receptor antagonist finerenone is associated with lower cardiovascular mortality and fewer worsening heart failure events across all body mass index levels.
Greater benefits from finerenone are observed in patients with higher body mass indexes.

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PURPOSE OF REVIEW: Obesity is an important risk factor for heart failure with preserved ejection fraction (HFpEF). In patients who already have HFpEF, obesity contributes to high symptom burden and increased risk for heart failure (HF) hospitalization. This review examines the latest clinical trials assessing the efficacy of pharmacological interventions in the treatment of obesity-related HFpEF.

RECENT FINDINGS: Recent results from randomized clinical trials (RCTs) suggest that incretin-based therapies, including glucagon-like peptide-1 receptor agonists (GLP-1 RAs) (e.g., semaglutide) and dual glucose-dependent insulinotropic polypeptide (GIP)/GLP-1 RAs (e.g., tirzepatide), can improve quality of life, exercise tolerance, and markers of HF severity while promoting weight loss in patients with obesity and HFpEF. Some evidence also suggests that these therapies may reduce risk for HF hospitalizations. Additionally, exploratory analyses of the nonsteroidal mineralocorticoid receptor antagonist finerenone has been associated with reduced cardiovascular mortality and total worsening HF events across all body mass index (BMI) levels, with greater benefits observed in patients with higher BMIs.

SUMMARY: Antiobesity medications such as semaglutide and tirzepatide may represent important treatment options for patients with obesity-related HFpEF. Additional evidence suggests that certain other HF medications may have increased efficacy in patients with obesity.

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Advances in the management of obesity and heart failure: latest evidence from clinical trials

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