heart failure
More analysis on Wegovy in heart failure
Yesterday, researchers reported trial results showing that Novo Nordisk's Wegovy improved physical function in patients with heart failure with preserved ejection fraction (HFpEF) along with obesity and diabetes. This followed positive trial findings last year in a similar population but without diabetes. Researchers have now pooled the data from these two trials in an analysis published in the Lancet today. Here are some interesting tidbits:
In subgroup analyses, they found that Wegovy led to greater improvements in symptoms in patients who started out with higher NT-proBNP levels and who had a history of atrial fibrillation, which are both markers of more severe heart failure. The fact that more advanced patients seemed to benefit more from Wegovy points to the idea that the drug "does something fundamental to changing the pathobiology of heart failure," said Mikhail Kosiborod, lead investigator and vice president of research at Saint Luke's Health System.
Those subgroups saw greater heart failure improvements even though the amount of weight they lost on Wegovy was about the same as other participants, supporting the emerging hypothesis that Wegovy benefits the heart through mechanisms beyond just weight loss, such as reducing inflammation and direct actions on the heart.
In the pooled analysis, the researchers also saw that there was a lower rate of infectious disease complications in people treated with Wegovy. The authors noted that obesity, diabetes, and heart failure are all conditions that increase inflammation and raise the risk of infections.
equity
How to actually get global heart disease rates down
Amid the stream of data coming out on novel drugs and devices, some researchers reminded us of the sobering reality that these innovations are out of reach for much of the world, and different approaches are needed to address rising rates of obesity, diabetes, and cardiovascular disease, particularly in low- and middle-income countries.
At a symposium today hosted by ACC and the European Society of Cardiology, Annika Rosengren, a professor at the University of Gothenburg in Sweden, said that at a population level, what's needed to bring down disease rates are lifestyle and policy changes.
"Even though we now have access to effective medications, this will only reduce part of the problem. Most of the people in the world can't even afford cardiovascular medications," she said. "Medicines won't solve this."
Meanwhile, Valentin Fuster, president of Mount Sinai Heart, touted the use of a polypill, a single compound made up of multiple drugs that can be cheaply manufactured and distributed, and is more convenient for patients to take consistently. He and other researchers showed in 2022 that a polypill reduced the risk of heart complications compared with regular care. That pill has been added to the World Health Organization's list of essential medicines, but is not currently available in the U.S.
When asked how the idea of widely distributing a polypill meshes with the trend toward understanding each patient's risk factors and personalizing treatment, Fuster said, "when you talk about the overall world, my friend, there's very little to personalize."
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