Association of Sacubitril/Valsartan with Metabolic Parameters in Patients with Reduced Ejection Fraction Heart Failure at a Multidisciplinary Clinic

Ryu, Rachel; Tran, Huyentran; Bahjri, Khaled

doi:10.1089/met.2020.0100

Cited by 4 publications

(2 citation statements)

References 20 publications

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“…No data are available on the effects of either the soluble guanylate cyclase stimulator vericiguat or the myosin activator omecamtiv mecarbil on body weight. In a retrospective observational study of HFrEF patients treated with sacubitril/valsartan, body weight remained unchanged at 3-, 6-, and 12-month follow-up [140]. In contrast, SGLT2i caused a moderate weight loss of 1–3 kg in randomized trials and real-world studies including patients with diabetes or HF [141-143].…”

Section: Resultsmentioning

confidence: 99%

The Obesity Paradox in Heart Failure: Is It Still Valid in Light of New Therapies?

et al. 2022

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Background: Obesity increases the risk of cardiovascular disease and heart failure (HF). However, in patients with established HF, many studies observed greater survival with increasing adiposity. This counterintuitive observation has been termed the “obesity paradox”. In recent years, new HF therapies have emerged that improve prognosis in patients with HF. Some of these, such as sodium-glucose cotransporter 2 inhibitors (SGLT2i), cause weight loss and may therefore interfere with the obesity paradox. Summary: This article is a narrative review on the relationship between body weight and outcomes in patients with HF with special focus on new HF treatments. PubMed was searched for studies reporting the prognostic impact of obesity in HF from 2002 to February 22nd 2022. More than 400 records were examined, with 150 being included in the present review. Literature provides evidence for an obesity paradox in a broad range of HF patients, including acute and chronic HF across the spectrum of left ventricular ejection fraction. It has been verified in HF patients treated with SGLT2i but not in those using sacubitril/valsartan. Cardiorespiratory fitness and severity of HF seem to be important confounders of the obesity paradox in HF. While unintentional weight loss is associated with a poor prognosis in HF, weight loss associated with SGLT2i treatment appears safe. Key messages: Consensus has yet to emerge as to whether the obesity paradox is a true phenomenon in HF. As cardiorespiratory fitness is strongly associated with prognosis and significantly modifies the relationship between adiposity and survival in HF, regular physical activity is recommended irrespective from body weight. In HF patients with severe obesity, a modest weight reduction of 5-10% may be reasonable to improve HF symptoms and quality of life.

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Section: Resultsmentioning

confidence: 99%

The Obesity Paradox in Heart Failure: Is It Still Valid in Light of New Therapies?

et al. 2022

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“…Mineralocorticoid receptor antagonists have a neutral effect on body weight (33). A retrospective observational study that followed the effects of sacubitril/valsartan (ARNI) in patients with HFrEF showed no effect of the drug on body weight during a 12month followup (34). SGLT2 inhi bitors (dapagliflozin and empagliflozin) have a moderate effect on body weight loss (average 13 kg) in randomized studies that followed patients with diabetes mellitus or heart failure (35).…”

Section: Heart Failure Therapy Challenges In Obese Patientsmentioning

confidence: 99%

Heart failure therapy challenges in obese patients

Đenić¹

2023

Med gl Spec bol štit Zlatibor

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Obesity is one of the most significant independent risk factor for developing heart failure (HF) through direct and indirect mechanisms. Excessive secretion of aldosterone and activation of the renin-angiotensin system (RAAS) in obese patients leads to sodium retention and an increase in extracellular volume, which contributes to the development of heart failure and increased cardiovascular risk. Abdominal visceral obesity is associated not only with an increased risk for the development of heart failure with preserved ejection fraction (HFpEF), but also with a high risk for the development of diabetes mellitus and hypertension in both sexes, but more dominantly in women, with an increase in incidence with menopause. Multiple studies and meta-analyses have confirmed that obese patients with heart failure regardless of ejection fraction (HFpEF and HFrEF) have better survival compared to those of normal or underweight, a phenomenon known as the obesity paradox. The HF-ACTION trial showed that even small improvements in cardiorespiratory fitness could lead to significant improvements in cardiovascular outcomes, reducing the impact of the obesity paradox on the clinical outcome of heart failure. The ESC recommendations for heart failure advise weight loss in order to prevent cardiovascular disease in obese and overweight patients, and gradual weight loss should be considered in patients with heart failure and BMI > 35 kg/m2 , while in patients with heart failure and BMI<35 kg/m2 , weight loss is not recommended. The goal of bariatric procedures is to prevent or delay the onset of heart failure, not only by reducing body weight but also by reducing risk factors. The randomized DAPA-HF trial showed that the use of dapagliflozin proved to reduce the composite outcome of worsening heart failure or cardiovascular death in heart failure patients with BMI>30 kg/m2 and in HF patients with BMI<30 kg/m2 . The EMPEROR-preserved and DELIVER trials showed that therapy with SGLT2 inhibitors in patients with HFpEF and BMI>30kg/m2 reduces the risk of hospitalization and cardiovascular death. It is recommended that patients in the terminal stage of heart failure in the pre-transplantation period and placed on the list for heart transplantation achieve target values of BMI<30 kg/m2 in order to achieve a better clinical outcome and reduce mortality after transplantation.

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Impact of Sacubitril/Valsartan on Lipid Parameters in Patients with Heart Failure with Reduced Ejection Fraction

et al. 2022

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Association of Sacubitril/Valsartan with Metabolic Parameters in Patients with Reduced Ejection Fraction Heart Failure at a Multidisciplinary Clinic

Cited by 4 publications

References 20 publications

The Obesity Paradox in Heart Failure: Is It Still Valid in Light of New Therapies?

The Obesity Paradox in Heart Failure: Is It Still Valid in Light of New Therapies?

Heart failure therapy challenges in obese patients

Impact of Sacubitril/Valsartan on Lipid Parameters in Patients with Heart Failure with Reduced Ejection Fraction

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