Semaglutide in HFpEF across obesity class and by body weight reduction: a prespecified analysis of the STEP-HFpEF trial.

Autor: Borlaug BA; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA., Kitzman DW; Department of Cardiovascular Medicine and Section on Geriatrics and Gerontology, Wake Forest University School of Medicine, Winston-Salem, NC, USA., Davies MJ; Diabetes Research Centre, University of Leicester, Leicester, UK.; NIHR Leicester Biomedical Research Centre, Leicester, UK., Rasmussen S; Novo Nordisk A/S, Søborg, Denmark., Barros E; Novo Nordisk A/S, Søborg, Denmark., Butler J; Baylor Scott and White Research Institute, Dallas, TX and Department of Medicine, University of Mississippi, Jackson, MS, USA., Einfeldt MN; Novo Nordisk A/S, Søborg, Denmark., Hovingh GK; Novo Nordisk A/S, Søborg, Denmark., Møller DV; Novo Nordisk A/S, Søborg, Denmark., Petrie MC; School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK., Shah SJ; Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA., Verma S; Division of Cardiac Surgery, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Unity Health Toronto, University of Toronto, Toronto, ON, Canada., Abhayaratna W; College of Health and Medicine, The Australian National University, Canberra, ACT, Australia., Ahmed FZ; Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK., Chopra V; Clinical Cardiology, Heart Failure and Research, Max Super Specialty Hospital, Saket, New Delhi, India., Ezekowitz J; University of Alberta, Edmonton, AB, Canada., Fu M; Section of Cardiology, Department of Medicine, Sahlgrenska University Hospital-Ostra, Gothenburg, Sweden., Ito H; Department of General Internal Medicine 3, Kawasaki Medical School, Okayama, Japan., Lelonek M; Department of Noninvasive Cardiology, Medical University of Lodz, Lodz, Poland., Melenovsky V; Institute for Clinical and Experimental Medicine - IKEM, Prague, Czech Republic., Núñez J; Hospital Clínico Universitario de Valencia, INCLIVA, Universidad de Valencia, and CIBER Cardiovascular, Valencia, Spain., Perna E; Instituto de Cardiologia J. F. Cabral, Corrientes, Argentina., Schou M; Department of Cardiology, Herlev-Gentofte Hospital, University of Copenhagen, Herlev, Denmark., Senni M; Cardiovascular Department, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy., van der Meer P; Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands., Von Lewinski D; Division of Cardiology, Medical University of Graz, Graz, Austria., Wolf D; Cardiology and Angiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany., Kosiborod MN; Department of Cardiovascular Disease, Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA. mkosiborod@saint-lukes.org.
Jazyk: angličtina
Zdroj: Nature medicine [Nat Med] 2023 Sep; Vol. 29 (9), pp. 2358-2365. Date of Electronic Publication: 2023 Aug 27.
DOI: 10.1038/s41591-023-02526-x
Abstrakt: In the STEP-HFpEF trial, semaglutide improved symptoms, physical limitations and exercise function and reduced body weight in patients with obesity phenotype of heart failure and preserved ejection fraction (HFpEF). This prespecified analysis examined the effects of semaglutide on dual primary endpoints (change in Kansas City Cardiomyopathy Questionnaire-Clinical Summary Score (KCCQ-CSS) and body weight) and confirmatory secondary endpoints (change in 6-minute walk distance (6MWD), hierarchical composite (death, HF events, change in KCCQ-CSS and 6MWD) and change in C-reactive protein (CRP)) across obesity classes I-III (body mass index (BMI) 30.0-34.9 kg m - 2 , 35.0-39.9 kg m - 2 and ≥40 kg m - 2 ) and according to body weight reduction with semaglutide after 52 weeks. Semaglutide consistently improved all outcomes across obesity categories (P value for treatment effects × BMI interactions = not significant for all). In semaglutide-treated patients, improvements in KCCQ-CSS, 6MWD and CRP were greater with larger body weight reduction (for example, 6.4-point (95% confidence interval (CI): 4.1, 8.8) and 14.4-m (95% CI: 5.5, 23.3) improvements in KCCQ-CSS and 6MWD for each 10% body weight reduction). In participants with obesity phenotype of HFpEF, semaglutide improved symptoms, physical limitations and exercise function and reduced inflammation and body weight across obesity categories. In semaglutide-treated patients, the magnitude of benefit was directly related to the extent of weight loss. Collectively, these data support semaglutide-mediated weight loss as a key treatment strategy in patients with obesity phenotype of HFpEF. ClinicalTrials.gov identifier: NCT04788511 .
(© 2023. The Author(s).)
Databáze: MEDLINE
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