Obesity and heart failure with preserved ejection fraction: focus on new drugs and future direction in medical treatment

Q: What is the clinical evidence from this study?

Study design: Review. Population: Obesity and heart failure with preserved ejection fraction (HFpEF). Intervention: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs).

Se-Eun Kim; Byung‐Su Yoo

doi:10.3904/kjim.2024.387

April 30, 2025The Korean Journal of Internal MedicineOpen Access

Obesity and heart failure with preserved ejection fraction: focus on new drugs and future direction in medical treatment

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Key result

GLP-1 RAs drive weight loss and improve symptoms and clinical outcomes in obesity-related HFpEF.

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Why the study?

Obesity is a major risk factor for HFpEF through multiple pathophysiological pathways, and treatment targeting obesity shows potential for improving clinical outcomes.

Structured PICO

P

Population

Patients with obesity and heart failure with preserved ejection fraction (HFpEF)

I

Intervention

Medical therapies targeting obesity-associated HFpEF, including sodium-glucose cotransporter 2 (SGLT2) inhibitors and glucagon-like peptide-1 receptor agonists (GLP-1 RAs)

This review highlights the emerging role of SGLT2 inhibitors and GLP-1 receptor agonists in improving symptoms, quality of life, and clinical outcomes in patients with obesity-associated HFpEF.

Limitations

The mechanism of action of GLP-1 RAs in HFpEF remains uncertain.
Evidence of substantial clinical outcome improvement for HF events and CV mortality as primary outcomes is still needed.
Further randomized controlled trials are necessary to confirm findings for future anti-obesity drug candidates.

Implication

Hypothesis-generating for GLP-1 receptor agonists in obesity-HFpEF; prospective trials needed before clinical adoption.

Abstract

Obesity is a major risk factor for heart failure with preserved ejection fraction (HFpEF) and contributes through multiple pathophysiological pathways, including systemic inflammation, neurohormonal activation, and mechanical inhibition. The treatment of obesity has shown significant potential for improving HFpEF outcomes. Sodium-glucose cotransporter 2 inhibitors have emerged as effective treatments for improving symptoms and quality of life in patients with HFpEF while aiding in weight control. Furthermore, a recent demonstration of the clinical benefits of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) in HFpEF showed promising results in reducing weight loss, and improving symptoms and clinical outcomes. In this review article, we discuss the association between HFpEF and obesity, the emerging role of GLP-1 RAs, and future directions for medical therapies targeting obesity-associated HFpEF.

Discussion

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Cite This Study

Kim et al. (2025) conducted a review in Obesity and heart failure with preserved ejection fraction (HFpEF). Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) was evaluated. Glucagon-like peptide-1 receptor agonists effectively induce weight loss and improve symptoms, quality of life, and clinical outcomes in patients with obesity and heart failure with preserved ejection fraction.

synapsesocial.com/papers/6a077d6b047d6f4f368b3494 https://doi.org/10.3904/kjim.2024.387