Obesity raises the risk of heart failure with preserved ejection fraction (HFpEF), but the cardiovascular benefits of GLP-1 RAs in these patients have been has remained uncertain. A meta-analysis published in Diabetes, Obesity and Metabolism evaluated data from 1876 patients with obesity and HFpEF across 3 randomized controlled trials.

Obesity increases the risk of heart failure with preserved ejection fraction (HFpEF), yet the cardiovascular benefit of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) has remained uncertain. A meta-analysis published in Diabetes, Obesity and Metabolism pooled data from 1876 obese patients across 3 randomized controlled trials.

GLP-1 RAs did not reduce cardiovascular or all-cause mortality but were associated with a 60% reduction in heart failure events (RR 0.40; 95% CI 0.22–0.73; p=0.003). Patients treated with GLP-1 RAs showed better quality of life, with a Kansas City Cardiomyopathy Questionnaire Clinical Summary Score (KCCQ-CSS) increase of 7.23 points, and improved functional capacity, with a 16.54-m gain in 6-minute walk distance. Average bodyweight decreased by 9.76 kg.

However, treatment was linked to higher discontinuation rates due to adverse events (RR 2.36; 95% CI 1.16–4.79; p=0.02), driven primarily by gastrointestinal intolerance (RR 4.01; 95% CI 2.15–7.45; p<0.01). These results support symptomatic and functional benefits of GLP-1 RAs in obese HFpEF, while highlighting tolerability concerns and the need for further validation in larger trials.