Inflammation in Obesity-Related HFpEF

Journal of the American College of Cardiology, Journal Year: 2024, Volume and Issue: 84(17), P. 1646 - 1662

Published: Aug. 30, 2024

Inflammation is thought to be an important mechanism for the development and progression of obesity-related heart failure with preserved ejection fraction (HFpEF). In STEP-HFpEF Program, once-weekly 2.4 mg semaglutide improved failure-related symptoms, physical limitations, exercise function, reduced levels C-reactive protein (CRP), a biomarker inflammation, body weight in participants HFpEF. However, neither prevalence nor clinical characteristics patients who have various magnitudes inflammation context HFpEF been well described. Furthermore, whether beneficial effects on HF efficacy endpoints Program are modified by baseline has not fully established. Finally, relationship between reduction changes CRP across defined.

Language: Английский

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Obesity and cardiovascular disease: an ESC clinical consensus statement

European Journal of Preventive Cardiology, Journal Year: 2024, Volume and Issue: unknown

Published: Aug. 30, 2024

The global prevalence of obesity has more than doubled over the past four decades, currently affecting a billion individuals. Beyond its recognition as high-risk condition that is causally linked to many chronic illnesses, been declared disease per se results in impaired quality life and reduced expectancy. Notably, two-thirds obesity-related excess mortality attributable cardiovascular disease. Despite increasingly appreciated link between broad range manifestations including atherosclerotic disease, heart failure, thromboembolic arrhythmias, sudden cardiac death, underrecognized sub-optimally addressed compared with other modifiable risk factors. In view major repercussions epidemic on public health, attention focused population-based personalized approaches prevent weight gain maintain healthy body from early childhood throughout adult life, well comprehensive loss interventions for persons established obesity. This clinical consensus statement by European Society Cardiology discusses current evidence epidemiology aetiology obesity; interplay obesity, factors conditions; management patients strategies lifestyle changes, interventional procedures, anti-obesity medications particular focus their impact cardiometabolic outcomes. document aims raise awareness factor provide guidance implementing evidence-based practices prevention optimal within context primary secondary prevention.

Language: Английский

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Semaglutide in obesity-related heart failure with preserved ejection fraction and type 2 diabetes across baseline HbA1c levels (STEP-HFpEF DM): a prespecified analysis of heart failure and metabolic outcomes from a randomised, placebo-controlled trial

The Lancet Diabetes & Endocrinology, Journal Year: 2025, Volume and Issue: unknown

Published: Jan. 1, 2025

Language: Английский

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Glucagon like peptide-1 (GLP-1) agonists and cardiometabolic protection: historical development and future challenges

Cardiovascular Diabetology, Journal Year: 2025, Volume and Issue: 24(1)

Published: Jan. 29, 2025

Language: Английский

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The promise of glucagon-like peptide 1 receptor agonists (GLP-1RA) for the treatment of obesity: a look at phase 2 and 3 pipelines

Expert Opinion on Investigational Drugs, Journal Year: 2025, Volume and Issue: unknown, P. 1 - 19

Published: March 1, 2025

Introduction GLP-1-based therapies have changed the treatment of overweight/obesity. Liraglutide 3.0 mg daily, first GLP-1 RA approved for overweight, induced a weight loss 6–8%, Semaglutide 2.4 once weekly improved to about 12–15%, while dual GIP/GLP-1 receptor agonist tirzepatide has 20% in obese people without diabetes.

Language: Английский

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Semaglutide in Patients With Obesity and Heart Failure Across Mildly Reduced or Preserved Ejection Fraction

Journal of the American College of Cardiology, Journal Year: 2023, Volume and Issue: 82(22), P. 2087 - 2096

Published: Oct. 9, 2023

Many therapies for heart failure (HF) have shown differential impact across the spectrum of left ventricular ejection fraction (LVEF).

Language: Английский

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Approach to Obesity Treatment in Primary Care

JAMA Internal Medicine, Journal Year: 2024, Volume and Issue: 184(7), P. 818 - 818

Published: March 11, 2024

Importance More than 40% of US adults have obesity, which increases the risks for multiple chronic diseases and premature mortality. Historically, nonsurgical interventions often not led to sufficient weight loss maintenance improve health, but highly effective antiobesity medications (AOMs) recently become available, additional therapeutics are under development. Given that most medical care with obesity is delivered in primary settings, guidance integrating weight-management approaches needed. Observations Lifestyle can lead a mean 2% 9% initial at 1 year increase likelihood 5% or more, regain over time common even continued treatment. Adjunctive treatments, including AOMs surgical approaches, larger, more sustained improvements numerous obesity-associated conditions. Highly AOMs, nutrient-stimulated hormone-based therapies, induce 15% more. Barriers intervention, access care, disproportionate influence on populations affected by its consequences. Conclusions Relevance Primary clinicians play vital role assessment, management, support patients obesity. With careful clinical assessment shared decision-making, flexible treatment plan be developed reflects evidence efficacy, patient preference, feasibility implementation. therapies lifestyle interventions, pharmacotherapeutics offer hope potential considerable health quality life.

Language: Английский

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The Emerging Role of Glucagon-like Peptide-1 Receptor Agonists in the Management of Obesity-Related Heart Failure with Preserved Ejection Fraction: Benefits beyond What Scales Can Measure?

Biomedicines, Journal Year: 2024, Volume and Issue: 12(9), P. 2112 - 2112

Published: Sept. 16, 2024

Obesity is a significant predisposing factor for heart failure with preserved ejection fraction (HFpEF). Although substantial proportion of individuals HFpEF also have obesity, those obesity are under-represented in clinical trials failure. In turn, current guidelines provided limited recommendations the medical management this patient population. Both and diabetes induce pro-inflammatory state that can contribute to endothelial dysfunction coronary microvascular impairment, finally resulting HFpEF. Additionally, leads increased epicardial chest wall adiposity, which enhances ventricular interdependence. This condition further aggravated by plasma blood volume expansion excessive vasoconstriction, ultimately worsening Despite well-documented benefits GLP-1 receptor agonists subjects diabetes, or both, their role obesity-related remains unclear. light recently published literature, review aims investigate potential mechanisms synthesize available evidence regarding patients

Language: Английский

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Effects of tirzepatide on circulatory overload and end-organ damage in heart failure with preserved ejection fraction and obesity: a secondary analysis of the SUMMIT trial

Nature Medicine, Journal Year: 2024, Volume and Issue: unknown

Published: Nov. 17, 2024

Abstract Patients with obesity-related heart failure preserved ejection fraction (HFpEF) display circulatory volume expansion and pressure overload contributing to cardiovascular–kidney end-organ damage. In the SUMMIT trial, patients HFpEF obesity were randomized long-acting glucose-dependent insulinotropic polypeptide receptor glucagon-like peptide-1 agonist tirzepatide ( n = 364, 200 women) or placebo 367, 193 women). As reported separately, decreased cardiovascular death worsening failure. Here, in this mechanistic secondary analysis of treatment at 52 weeks, as compared placebo, reduced systolic blood (estimated difference (ETD) −5 mmHg, 95% confidence interval (CI) −7 −3; P < 0.001), estimated (ETD −0.58 l, CI −0.63 −0.52; 0.001) C-reactive protein levels −37.2%, −45.7 −27.3; 0.001). These changes coupled an increase glomerular filtration rate 2.90 ml min −1 1.73 m −2 yr , 0.94 4.86; 0.004), a decrease urine albumin–creatinine ratio 24 −25.0%, −36 −13%; 0.001; −15%, −28 0.1; 0.051), reduction N-terminal prohormone B-type natriuretic peptide weeks −10.5%, −20.7 1.0%; 0.07) troponin T −10.4%, −16.7 −3.6; 0.003). post hoc exploratory analyses, was significantly correlated pressure, microalbuminuria, improved Kansas City Cardiomyopathy Questionnaire Clinical Summary Score increased 6-min walk distance. Moreover, conclusion, volume–pressure systemic inflammation mitigated injury obesity, providing new insights into mechanisms benefit from tirzepatide. ClinicalTrials.gov registration: NCT04847557 .

Language: Английский

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Obesity: the perfect storm for heart failure

ESC Heart Failure, Journal Year: 2024, Volume and Issue: 11(4), P. 1841 - 1860

Published: March 15, 2024

Abstract Obesity condition causes morphological and functional alterations involving the cardiovascular system. These can represent substrates for different diseases, such as atrial fibrillation, coronary artery disease, sudden cardiac death, heart failure (HF) with both preserved ejection fraction (EF) reduced EF. Different pathogenetic mechanisms may help to explain association between obesity HF including left ventricular remodelling epicardial fat accumulation, endothelial dysfunction, microvascular dysfunction. Multi‐imaging modalities are required appropriate recognition of subclinical systolic dysfunction typically associated obesity, echocardiography being most cost‐effective technique. Therapeutic approach in patients is challenging, particularly regarding EF which few strategies high level evidence available. Weight loss extreme importance HF, a primary therapeutic intervention. Sodium–glucose co‐transporter‐2 inhibitors have been recently introduced novel tool management patients. The present review aims at analysing recent studies supporting pathogenesis, diagnosis, HF.

Language: Английский

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