Pharmacological treatment for patients with obesity and heart failure - Focus on glucagon-like peptide-1 receptor agonists

Sep 29, 2026

Pharmacological treatment for patients with obesity and heart failure: Focus on glucagon-like peptide-1 receptor agonists presents an expert consensus on using GLP-1 receptor agonists (GLP-1 RAs) and dual GIP/GLP-1 receptor agonists in heart failure. It reviews clinical integration, patient selection, safety, and tolerability, emphasizing evidence in HF with preserved ejection fraction (HFpEF) where trials show weight reduction and improved health status and exercise capacity. It also identifies limited data on reducing HF events or cardiovascular mortality and highlights scarce efficacy and safety evidence for HF with reduced ejection fraction, with outcome trials pending.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages15

Reading Time38 min

AccessFree to download

Introduction

Rationale for therapy in obesity and heart failure

Gut–brain axis and enteroendocrine hormones

Expert consensus scope

GLP-1 RAs and GIP/GLP-1 RA therapeutic options

Clinical integration and patient selection

Safety and tolerability

Evidence summary in HFpEF

Effects on body weight and health status

Uncertainty regarding HF events and mortality

Evidence gaps in HFrEF

Current limitations and pending outcome trials

European Journal of Heart Failure (2025) 27, 2465–2479 REVIEW ARTICLE doi:10.1002/ejhf.70082 Pharmacological treatment for patients with obesity and heart failure: Focus on glucagon-like peptide-1 receptor agonists. European Journal of Heart Failure expert consensus document Luca Monzo 1, Gianluigi Savarese2, Wilfried Mullens3,4, Amr Abdin5, Biykem Bozkurt6, Ovidiu Chioncel7,8, Seif El Hadidi9, Thomas M. Gorter 10, Riccardo M. Inciardi 11, Mark C . Petrie 12, Gabriele G. Schiattarella 13,14,15,16,17,18, Davide Stolfo2,19, Marco Metra 11, and Nicolas Girerd 1* 1 Centre d’Investigations Cliniques Plurithématique 1433 and INSERM U 1116-DCAC, CHRU Nancy, F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Université de Lorraine, Nancy, France; 2 Department of Clinical Science and Education, Södersjukhuset; Karolinska Institutet, Stockholm, Sweden; 3 Department of Cardiology, Ziekenhuis Oost-Limburg A.V., Genk, Belgium; 4 Hasselt University, Faculty of Medicine and Life Sciences, Diepenbeek, Belgium; 5 Internal Medicine Clinic III, Cardiology, Angiology and Intensive Care Medicine, Saarland University Hospital, Homburg, Germany; 6Winters Center for Heart Failure Research, Cardiovascular Research Institute, Baylor College of Medicine, Houston, TX, USA; 7 Emergency Institute for Cardiovascular Diseases ‘Prof. C.C. Iliescu’, Bucharest, Romania; 8 University of Medicine Carol Davila, Bucharest, Romania; 9 Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland; 10Department of Cardiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands; 11 Institute of Cardiology, ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy; 12School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK; 13Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Max Rubner Center for Cardiovascular Metabolic Renal Research (MRC), Berlin, Germany; 14DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany; 15Translational Approaches in Heart Failure and Cardiometabolic Disease, Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany; 16Friede Springer Cardiovascular Prevention Center at Charité – Universitätsmedizin Berlin, Berlin, Germany; 17Experimental and Clinical Research Center (ECRC), a Cooperation of Charité-Universitätsmedizin Berlin and Max Delbruck Center for Molecular Medicine (MDC), Berlin, Germany; 18Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy; and 19Cardiology, Cardiothoracic Department, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy Received 6 September 2025; revised 25 September 2025; accepted 7 October 2025 ; online publish-ahead-of-print 27 November 2025 There is growing clinical interest in strategies for improving clinical outcomes in patients with heart failure (HF) and obesity. The development of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and of the dual glucose-dependent insulinotropic polypeptide (GIP)/GLP-1 RA has expanded therapeutic options for this population. This expert consensus provides a comprehensive and pragmatic framework for the use of GLP-1 RAs and GIP/GLP-1 RA in patients with HF, focusing on clinical integration, patient selection, safety, and tolerability. We review the evidence supporting their use in patients with HF with preserved ejection fraction (HFpEF), where clinical trials have demonstrated meaningful reductions in body weight alongside improvements in health status and exercise capacity. Whether these effects translate into fewer HF events or lower cardiovascular mortality remains uncertain, as current evidence is limited to two small trials with few observed events. In contrast, data regarding the efficacy a

FAQs

Which therapies does the consensus document focus on for obesity with heart failure?

It focuses on glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and the dual GIP/GLP-1 RA as pharmacological options for patients with heart failure and obesity.

What evidence is highlighted for HF with preserved ejection fraction (HFpEF)?

Clinical trials in HFpEF have shown meaningful reductions in body weight along with improvements in health status and exercise capacity.

Why is the document uncertain about hard outcomes like HF events or cardiovascular mortality?

The document notes that evidence is limited, restricted to a small number of small trials with few observed events, so whether benefits translate to fewer HF events or lower mortality remains unclear.

Sep 29, 2026

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