How semaglutide impacts HFpEF

The results of the STEP-HFpEF trial showed statistically significant benefits “across the board” and these benefits were not due to weight loss alone, according to Vicky Ruszala, Specialist Cardiology Pharmacist, North Bristol NHS Trust.

“The findings [of the STEP-HFpEF trial] were very definitive”, says Ms Ruszala. There was an eight-point difference in the Kansas City Cardiomyopathy Questionnaire (KCCQ) score. (A minimum four-point difference is clinically significant). “The patients who were on semaglutide felt much better, had far, far less symptoms and were able to do more in their daily life with increased exercise capacity”, she explains. In addition, there was an 11 percent greater body weight loss in the semaglutide group compared with the placebo group. Both endpoints were statistically significant. Furthermore, the hierarchical secondary endpoints were all met.

The key points to note are:

• There was a significant difference in the 6-minute walk distance (6MWD)
• There were 13 heart failure events (e.g. death or hospitalisation) in total, 12 of which occurred in the placebo group
• Greater reductions were seen in C-reactive protein (CRP) levels and N-terminal pro B-type natriuretic peptide (NT-proBNP) levels in the treatment group

The results suggest that obesity may have a causative role in heart failure and that this is related to inflammatory processes. If semaglutide reduces inflammatory activity, “potentially, you are going to end up with cardiac remodelling and Improvement overall in how the heart functions by using this drug versus not doing anything at all. It’s not just the weight loss that’s causing the benefits”, explains Ms Ruszala.

Previous trials of weight loss combined with exercise have shown benefits in quality of life but not to the same extent as those seen with semaglutide. Weight loss is known to be beneficial in HFpEF but previous obesity trials have not looked at other markers (e.g. inflammatory markers), she explains. Moreover, “the weight loss itself wasn’t significant enough in many of the previous trials, so there was something extra seen in [this trial] that wasn’t previously. So, we know weight loss is of benefit and there’s no ….  taking away from lifestyle management – but it still didn’t achieve as much as it did in [this trial]”, concludes Ms Ruszala.

About Vicky Ruszala

As a specialist cardiology pharmacist, a large part of Vicky Ruszala’s work involves optimising medications for heart failure. She works on the specialist cardiology ward and also has two heart failure clinics each week.  She is an independent prescriber and has her own patient caseload.

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