Clinical trials investigating treatments and prognosis for patients with heart failure
The anti-diabetic and weight-loss drug semaglutide, sold under the brand names Ozempic and Wigovy, can also help patients with heart failure and obesity lose weight while improving symptoms and improving athletic performance, the journal says. According to clinical trials, New England Medical Journal.
Although obesity is known to be a major risk factor for heart disease, it has only recently been recognized as a major risk factor for heart failure with preserved ejection fraction. Obesity is increasing in prevalence, affecting more than 50 percent of heart failure patients, and treatment options are limited, said the study’s co-author, Deep Phenotyping Research Institute for Artificial Intelligence and Medicine. said Sanjiv Shah, MD, Neil J. Stone, MD, professor and director of the Precision Therapy Center. .
“When this was first recognized in the early 1980s, this heart failure syndrome with preserved ejection fraction was thought to be caused by hypertension and coronary artery disease,” Shah said. “However, over the ensuing decades, the epidemiology of preserved ejection fraction heart failure has changed due to the alarming obesity and diabetes epidemics. The main risk factors for this type of heart failure are obesity and sedentary lifestyle. It’s a unique lifestyle.”
The main abnormality in heart failure patients with preserved ejection fraction is not the heart’s pumping function. Instead, the heart muscle becomes stiffer and cannot properly fill the heart with blood. As a result, pressure from the lungs backs up and the heart is unable to meet the body’s demands, which can cause severe shortness of breath, swelling of the legs and abdomen, decreased quality of life, and poor prognosis.
Given the critical unmet need for heart failure with preserved ejection fraction and the key role of obesity in its development, Shah and other experts have developed a new class of weight-loss drugs called GLP1 receptor agonists. He was passionate about researching the potential therapeutic role of drugs. Contains semaglutide. Ultimately, support for such trials led to the current study, in which 529 obese and heart failure patients with preserved ejection fraction received weekly semaglutide or placebo for 1 year, while others received no treatment. randomly assigned.
According to the study, patients who received semaglutide lost more weight, with an average percentage change in weight of -13.3% compared to -2.6% for patients who received a placebo. At the end of the study, patients who received semaglutide were able to walk farther and had lower levels of C-reactive protein, a biomarker of inflammation known to cause heart failure, than those who received a placebo. Ta. Importantly, patients receiving semgartide also had greater reductions in B-type natriuretic peptide, a biomarker that correlates with heart failure severity, compared to placebo.
“It was really surprising how effective it was as a weight loss drug, even in the setting of heart failure,” Shah said. “But what we were most interested in was whether the drug could reduce the symptoms and signs of heart failure itself. We found that patients treated with semaglutide (compared to placebo) could reduce the symptoms and signs of heart failure itself. We found that health status (including life eligibility, symptoms, and physical limitations) improved significantly. In fact, semaglutide improved health status more than any other heart failure treatment tested to date. it was done.”
Shah’s group at Northwestern Medicine will continue to study additional weight loss drugs to understand the potential benefits they may have for heart failure patients, he said.
“So many patients have been ignored and ignored by healthcare professionals for years because they are overweight. Obese patients suffer from undiagnosed heart failure, resulting in shortness of breath and inability to move. We often fall into this trap,” Shah said. “Clinical trials such as ours could raise awareness of obesity-induced heart failure and lead to it being diagnosed more frequently, or could lead to the treatment of obesity with GLP-1 receptor agonists and other anti-obesity drugs. I really hope it works.” Even if these patients are never formally diagnosed with heart failure, it could even prevent them from developing heart failure. ”
A small number of patients discontinued treatment due to adverse events: 35 in the semaglutide group and 14 in the placebo group. According to the study, gastrointestinal problems were the main cause.
This research was supported by Novo Nordisk.
Advances in predicting mortality from heart failure
Shah’s other recent studies have also provided additional insight into risk factors for heart disease and mortality.
Another recently published study co-authored by Shah found that CirculationThe researchers analyzed results from a previous clinical trial that investigated the effects of dapagliflozin in heart failure patients with preserved ejection fraction. SGLT2 This inhibitor blocks glucose absorption and increases urinary sodium and water loss, thereby treating the dangerous fluid retention that occurs in heart failure patients.
The researchers, including Shah, who also co-authored the original trial, compared medical events such as increased outpatient diuretic use and emergency visits and hospitalizations with subsequent mortality.
The results of the study showed that patients who had increased outpatient diuretic use had higher subsequent mortality rates, as did patients who presented for cardiac-related emergencies. The results showed that patients admitted with heart failure as an initial medical incident had the highest subsequent mortality rates. Dapagliflozin not only reduced the need for hospitalization for heart failure, but also reduced the need for outpatient diuretic intensification.
As overall heart failure hospitalizations decrease due to improved interventions and treatments, it is becoming increasingly important to track outpatient outcomes, Shah said.
“Decisions about whether to admit a patient vary widely among physicians and by region,” Shah said. “There is a big movement in the United States to avoid hospitalization because we want to keep readmission rates low. Our study shows that worsening heart failure in the outpatient setting is associated with a higher risk of poor outcomes, and this drug is We found that it is effective in reducing the deterioration of heart failure in patients.”
While the U.S. Food and Drug Administration has primarily focused on reduced hospitalizations as a positive outcome for clinical trials, Shah said the outpatient data could add more measurable results in future trials, and hopefully improve the outcome for heart failure. He said he hopes it will allow testing of new drugs and devices. We need to treat patients more quickly so they can get new treatments sooner.
“Recent advances in research on heart failure with preserved ejection fraction are promising,” Shah said. “After nearly 40 years of numerous neutral clinical trials, multiple effective drugs have finally been developed. Over the next few years, further advances in drug- and device-based treatments will be made, and this year marks the beginning of ‘ejection preservation. We predict this will be the 10th year of heart failure.” Fractional therapy, and ultimately providing some relief to suffering patients. ”
