Real-World Study of Cardiac Remodeling on Semaglutide and Tirzepatide Therapy Using Longitudinal Echocardiography
Incretin-based therapies like semaglutide and tirzepatide are associated with reductions in left ventricular mass that correlate with weight loss, but the clinical implications of these findings require cautious interpretation.
Where it sits
this study against the rest of the semaglutide corpusSummary and findings
This study evaluated longitudinal cardiac remodeling associated with semaglutide and tirzepatide in a cohort of 3,500 patients, stratified by weight loss. The findings indicated a decrease in left ventricular mass proportional to weight loss across different responder groups. No significant changes were observed in left atrial volume or left ventricular function.
Abstract
<h4>Background: </h4> Glucagon-like peptide-1 (GLP-1) and dual GLP-1/glucose-dependent insulinotropic polypeptide (GIP) receptor agonists reduce cardiovascular events, but the underlying cardiac structural remodeling remains unclear. <h4>Objectives:</h4> This study evaluated longitudinal cardiac remodeling associated with semaglutide and tirzepatide in a real-world cohort and determined its weight-loss dependency. <h4>Methods:</h4> Using electronic health records from a federated network, we analyzed longitudinal echocardiograms of patients prescribed semaglutide or tirzepatide, stratified by 12-month weight loss into super-responders (>15%), moderate-responders (5%-15%), and minimal-responders (<5%). Additionally, GLP-1/GIP patients with >5% weight loss were propensity-matched with non-GLP-1/GIP weight-loss medication control patients on demographics and baseline body mass index. <h4>Results:</h4> Among 3,500 GLP-1/GIP patients (422 weight-loss super-responders, 1,426 moderate-responder, 1,652 minimal-responders), left ventricular (LV) mass decreased across all groups proportional to weight loss (super-responders: 198.4 ± 69.6 to 176.6 ± 66.0 g; moderate-responders: 210.7 ± 74.0 to 195.8 ± 68.1 g; minimal-responders: 216.1 ± 68.4 to 204.8 ± 67.4 g; p < 0.001). Left atrial volume and LV systolic and diastolic function did not change. Among weight-loss super-responders, semaglutide (n = 159) showed greater LV mass reduction than tirzepatide (n = 89) (Cohen’s d = -0.389 vs. -0.263), while tirzepatide showed small improvements in right ventricular function. Compared to matched non-GLP-1/GIP controls (n = 118/group), GLP-1/GIP patients exhibited significant LV mass reduction not observed in controls despite similar weight loss. <h4>Conclusions:</h4> Real-world findings demonstrate that incretin-based therapies are associated with reverse cardiac remodeling characterized by weight-loss-dependent and incretin-specific mechanisms, with potentially distinct structural targets among agents.
Background
The paper addresses the impact of Semaglutide and Tirzepatide on cardiac remodeling, a critical aspect of cardiovascular health. Previous studies have indicated potential benefits of GLP-1 receptor agonists on heart structure and function, but real-world evidence is limited. This study aims to fill that gap by utilizing longitudinal echocardiography to assess changes over time.
Methods
Not reported in abstract.
Results
Not reported in abstract.
Interpretation
Not reported in abstract.
Key findings
- Not reported in abstract.
Limitations
- Not reported in abstract.