Oral Semaglutide Lowers Heart Failure Risk

A new study published on February 2 in JAMA Internal Medicine suggests that oral semaglutide may reduce the risk of heart failure-related events in people with type 2 diabetes. The benefit appears to be strongest among those with a specific, often difficult-to-treat form of heart failure known as HFpEF.

Understanding the Findings

The research found that oral semaglutide reduced the number of significant heart failure-related events in individuals with type 2 diabetes. The study involved a cohort of participants with an average age of 66 years, where almost one-third (29%) were female. Approximately one-quarter (2,229) of the participants had preexisting heart failure.

Did You Know? Annual health care costs associated with heart failure exceed $30 billion and are projected to grow to at least $70 billion annually by 2030.

Participants were randomly assigned to receive either daily oral semaglutide or a placebo. After four years of follow-up, those with existing heart failure who received oral semaglutide experienced a 22% lower risk of serious heart failure-related outcomes, including hospitalization and death. No significant benefit was observed in participants without pre-existing heart failure.

HFpEF and HFrEF Explained

The study differentiated between two main types of heart failure: HFrEF and HFpEF. In HFrEF, the heart muscle is too weak to pump blood effectively, with an ejection fraction of 40% or lower. HFpEF, however, involves a stiffened left ventricle that doesn’t fill properly, even though the heart still pumps 50% or more.

Expert Insight: The findings are “confirmatory, not ground-breaking,” according to Nancy K. Sweitzer, editor-in-chief of Circulation: Heart Failure, and professor of cardiology at Washington University in St. Louis School of Medicine. She suggests the results could help secure insurance coverage for these medications, which are clinically important for improving outcomes in patients with HFpEF.

The study revealed that those with HFpEF experienced a 41% lower risk of heart failure-related events, while those with HFrEF showed no statistically significant benefit.

The Bigger Picture

Type 2 diabetes and heart failure frequently occur together, and more than 1 in 5 people with type 2 diabetes also have heart failure. GLP-1 drugs, like semaglutide and tirzepatide, are used to treat diabetes and obesity and have also shown promise in improving cardiovascular and heart failure outcomes. Oral semaglutide may offer a more accessible treatment option for those with type 2 diabetes and HFpEF compared to injectable formulations.

Frequently Asked Questions

What is HFpEF?

HFpEF is a type of heart failure where the heart muscle is stiffened and doesn’t fill properly, even though it still pumps 50% or more of the blood with each beat.

What did the SOUL trial find?

The SOUL trial found that oral semaglutide reduced the risk of major adverse cardiovascular events (MACE), which includes heart attack, stroke, and death due to CVD in people with type 2 diabetes.

Was oral semaglutide safe in the study?

The study indicated no safety signal associated with oral semaglutide; the number of serious adverse events was similar between the semaglutide and placebo groups.

As research continues, it will be important to see if these findings are replicated in further studies and how oral semaglutide fits into the broader landscape of heart failure treatment.