Weight loss jabs that are set to rollout on the NHS could cure heart failure in obese people after a landmark study found they had a “significant effect” on symptoms, allowing them to exercise for longer and lose weight.
US researchers explored the use of semaglutide – which is sold under the brand names Ozempic, Wegovy and Rybelsus – to treat overweight people with a condition called heart failure with preserved ejection fraction (HFpEF).
HFpEF is when the heart pumps normally but is too stiff to fill properly. Symptoms include shortness of breath, swelling and physical limitations that can lead to a poor quality of life. Some one million people in the UK have heart failure and there are few treatment options are currently available.
The trial – the findings of which were presented at the ESC Congress in Amsterdam on Friday – included 529 patients, all of whom had a body mass index of more than 30, as well as heart failure symptoms. It found that using the weight loss jab allowed them to exercise for longer as well as lose weight, a new study has found.
The median age of the group was 69 and the median weight was 105.1kg – that ranges from a BMI of 31 for someone 6′ tall to 45 for someone just over 5′ tall. One group was given a once-weekly semaglutide 2.4 mg for one year while the other was given a placebo.
Researchers assessed changes in body weight, as well as changes to heart failure-related symptoms, using a scoring system based on the Kansas City Cardiomyopathy Questionnaire (KCCQ), which independently measures a patient’s perception of their health status and described by the research team as “gold standard”. They also determined whether patients were able to perform better walking for six minutes.
After one year the improvements among the semaglutide group were astonishing. The body weight for those on Wegovy also reduced by a mean of 13.3 per cent compared to 2.6 per cent. The mean change to walking distance in six minutes was 21.5 metres for those on Wegovy and 1.2 metres in the placebo group.
The researchers said the improvements were three times greater than the effects seen with any other previous drugs for heart failure, and that this would lead to a “paradigm shift” in how heart failure treatment was approached around the world.
Dr Mikhail Kosiborod, of Saint Luke’s Mid America Heart Institute in Kansas City who was principal investigator on the study, said Wegovy “produced large improvements in symptoms, physical limitations and exercise function, reduced inflammation, and resulted in greater weight loss and fewer serious adverse events as compared with placebo”.
He added: “To our knowledge, this is the first trial of a pharmacologic agent to specifically target obesity as a treatment strategy for HFpEF, and the magnitude of the benefits we observed is the largest seen with any agent in HFpEF. This will likely have a significant impact on clinical practice, especially since there is a dearth of efficacious therapies in this vulnerable patient group.
“We believe that these findings should also change the nature of the conversation about the role of obesity in HFpEF, as the Step-HFpEF results clearly indicate that obesity is not simply a comorbidity in patients with HFpEF but a root cause and a target for therapeutic intervention.”
The study was sponsored by Wegovy maker Novo Nordisk, which published its own findings from a five-year study on the drug earlier this month, showing the drug also cuts heart attacks and strokes by a fifth.. The Select trial included 17,604 adults over the age of 45 from across 41 countries, each with a BMI of 27 and over, established cardiovascular disease, and no history of diabetes.
Researchers found that the risk of heart attack or stroke in patients given a 2.4mg once-weekly dose of Wegovy, alongside standard care for the prevention of heart attacks or stroke, reduced by 20 per cent compared with those given a placebo drug.
Semaglutide works by suppressing the appetite, mimicking a hormone called GLP-1, which makes people feel full. It was originally developed to treat diabetes, but its “miracle” weight-loss effects mean it is now being used as an anti-obesity drug.
The UK’s medicine regulator authorised Wegovy as a weight loss treatment in September 2021. In March this year, the National Institute for Health and Care Excellence (NICE) recommended the injections be prescribed on the NHS in a push to relieve pressure on the service from obesity related treatment.
In June, Prime Minister Rishi Sunak announced a £40m two-year pilot which would look at whether GPs could offer the injections to patients rather than having to go through a specialist. This would be for people with at least one weight-related health condition, as well as those who have a BMI which is near the top of the obese range
However, as i revealed this month, the scheme has been delayed indefinitely due to soaring demand for the drug – which has delayed its NHS rollout – and may be scrapped altogether if Labour win the next election.
Dr Sonya Babu-Narayan, Associate Medical Director at the British Heart Foundation and consultant cardiologist, said: “Only a few years ago, drugs that could help people to achieve life-changing weight loss felt like a far-off dream. But now they are here. This study demonstrates that semaglutide is not only safe for people with this type of heart failure but it also has important benefits for their quality of life.
“For some people, living with heart failure can make everyday activities difficult or even impossible. The kind of improvements seen in this study, such as being able to walk further, could have a transformational impact on someone’s life.
“Obesity is on the rise in the UK and beyond, but most of us won’t need medication to help us lose weight. What we do need is to live in a society that makes the healthy option the easy option. That means an environment that can support everyone to maintain a healthy weight, for example by ensuring regular physical activity and eating well are accessible and cost effective.
“Meanwhile, it’s important that people with type 2 diabetes who rely on semaglutide to control their blood sugar are not put at risk if supply of the drug for new uses beyond diabetes control outstrips demand.”