In a recent study published in LancetResearchers investigated whether semaglutide was helpful for individuals with atherosclerotic heart problems and a history of heart failure.
Test: Semaglutide and cardiovascular outcomes in patients with obesity and chronic heart failure: a prespecified evaluation of the SELECT trial. Image Source: MillaF/Shutterstock.com
Entry
The worldwide rise in obesity has led to a rapid increase within the incidence of diabetes and heart problems. Semaglutide is a glucagon-like peptide-1 receptor agonist that induces weight reduction and reduces major adversarial cardiovascular events (MACE) in patients with diabetes.
Moreover, one study observed that semaglutide reduced MACE by 20% in non-diabetic patients with obesity/chubby and heart problems.
The rise in obesity can also be related to an increased incidence of heart failure. Most patients with obesity and heart failure have heart failure with preserved ejection fraction, which might be causally related to the pathological effects of obesity.
Although the several subtypes of heart failure (preserved and reduced ejection fraction) share many common clinical features, their causes and responses to treatment differ.
Concerning the study
This study examined the advantages of semaglutide in individuals with heart failure and obesity. This was a prespecified evaluation of the Semaglutide Effects on Heart Disease and Stroke in Patients with Obesity and Chubby (SELECT) trial.
Adults aged ≥ 45 years and with a body mass index (BMI) ≥ 27 kg/m were eligible for the study.2 and diagnosed heart problems (previous myocardial infarction, symptomatic peripheral arterial disease or hemorrhagic/ischemic stroke).
Study participants were randomly assigned to receive placebo or increasing doses of semaglutide once weekly for 16 weeks.
Primary outcomes were time to first MACE, composite heart failure, cardiovascular mortality, and all-cause mortality. Composite heart failure was defined as an urgent hospital visit or hospitalization for heart failure or cardiovascular death.
MACE was defined as a composite of nonfatal stroke, nonfatal myocardial infarction, or cardiovascular death.
Time to end result was assessed using a Cox proportional hazards model. Safety was assessed as the character and number of significant adversarial events or those who led to discontinuation of study drug.
Results
A complete of 17,604 patients were randomly assigned to receive semaglutide or placebo between October 31, 2018, and March 31, 2021. Their mean age and BMI were 61.6 years and 33.4 kg/m2.2appropriately.
The vast majority of participants (72.3%) were male, and 4286 had a history of heart failure at study entry. Of those, 666 had unclassified heart failure, 1347 had heart failure with reduced ejection fraction, and 2273 had heart failure with preserved ejection fraction.
Moreover, clinical features were well balanced between patients with and without (history of) heart failure. There have been more women amongst patients with heart failure with preserved ejection fraction than amongst patients with heart failure with reduced ejection fraction.
Furthermore, within the group with heart failure with reduced ejection fraction there have been more patients with a history of myocardial infarction.
The incidence of heart failure with preserved ejection fraction was related to higher baseline BMI. Patients with heart failure with reduced ejection fraction had lower mean systolic blood pressure than patients with heart failure with preserved ejection fraction.
As well as, a better proportion of patients with heart failure and reduced ejection fraction received aldosterone antagonists and loop diuretics.
Nobody was using an SGLT2 inhibitor at enrollment; nonetheless, 545 patients began using one in the course of the study period. There have been small differences between patients by heart failure subtype.
For instance, those with unclassified heart failure were older, more prone to be female, and had higher levels of high-sensitivity C-reactive protein. As well as, fewer patients with unclassified heart failure were receiving β-blockers at baseline than those in other heart failure subtype groups.
Placebo-treated individuals with heart failure at baseline had increased scores on all end result measures in comparison with those without heart failure. Semaglutide improved all end result measures in patients with heart failure.
The differences in event rates between semaglutide and placebo recipients emerged inside six months and increased with follow-up. Notably, semaglutide similarly improved all-cause mortality and MACE in patients and not using a history of heart failure.
Serious adversarial events were less common in people taking semaglutide than in people taking placebo, no matter heart failure.
Essentially the most common serious adversarial events were cardiac disorders. Amongst semaglutide recipients, discontinuation resulting from adversarial events was mainly resulting from gastrointestinal disorders.
The discontinuation rate in patients taking semaglutide was lowest amongst patients with heart failure with preserved ejection fraction.
Conclusions
Taken together, the outcomes indicate that treatment with semaglutide reduced MACE and the composite endpoint of heart failure in nondiabetic patients with atherosclerotic heart problems and obesity/chubby who had a history of heart failure at baseline.
Improvements in outcomes were seen soon after treatment initiation and were maintained throughout the study. The advantages of semaglutide didn’t differ between patients with heart failure subtypes.
Moreover, the clinical good thing about semaglutide was not depending on gender, age, clinical status, or baseline body mass index (BMI).
Overall, the efficacy results, along with a suitable safety profile, support using semaglutide together with standard of care to scale back the chance of major adversarial cardiovascular events (MACE) in obese/chubby individuals with atherosclerotic heart problems, no matter heart failure subtype.