Weight loss as the optimal cardiometabolic management strategy for preventing and treating heart failure

Published Mar 9, 2026Current opinion in cardiology

Weight loss as the best way to prevent and manage heart failure and related heart and metabolism problems

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Abstract

Intentional weight loss is currently recommended for individuals with obesity and heart failure with preserved ejection fraction (HFpEF).

Visceral adipose tissue and central obesity are linked to the development and progression of heart failure.
Incretin-based therapies, such as semaglutide and tirzepatide, may improve exercise capacity and quality of life in patients with HFpEF.
Patients with higher levels of obesity may experience greater benefits from incretin-based therapies and other treatments, including mineralocorticoid receptor antagonists and SGLT2 inhibitors.
Observational studies suggest that intentional weight loss may reduce heart failure risk, but randomized trials of antiobesity medications have not clarified this benefit.
The impact of intentional weight loss in heart failure with reduced ejection fraction (HFrEF) and its role in primary prevention remains uncertain.

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PURPOSE OF REVIEW: To synthesize current evidence supporting intentional weight reduction as a cardiometabolic strategy for treating and preventing heart failure (HF) across the ejection-fraction spectrum, examine the influence of baseline obesity on treatment effects of established HF therapies, and highlight key knowledge gaps and future research directions.

RECENT FINDINGS: Visceral adipose tissue, central obesity, and dysfunctional adipose mass are linked to the development and progression of HF with preserved ejection fraction (HFpEF). Recent trials show that incretin-based therapies (semaglutide, tirzepatide) improve exercise capacity, symptoms, and quality of life in HFpEF, and potentially reduce HF events. Patients with higher degrees of obesity may derive greater benefit from incretin-based therapies and other guideline-directed therapies, including mineralocorticoid receptor antagonists (MRA), sodium-glucose transport 2 (SGLT2) inhibitors, and angiotensin receptor-neprilysin inhibitor (ARNI). While observational studies suggest intentional weight loss may lower HF risk, randomized trials of antiobesity medications have yet to further clarify this potential benefit.

SUMMARY: Weight loss is currently recommended as an optimal strategy for individuals with obesity and HFpEF, given consistent benefits for exercise capacity, functional status, and quality of life, with a potential for reducing clinical events. Intentional weight loss impact in HFrEF and its role in primary HF prevention remains uncertain. Large, well designed cardiovascular outcome trials of intentional weight-loss interventions in populations with obesity and HF, or obesity and elevated HF risk, are needed to establish clinical efficacy and better define individuals who benefit from those interventions across the spectrum of ejection fraction.

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Weight loss as the optimal cardiometabolic management strategy for preventing and treating heart failure

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