Is Ozempic (semaglutide) safe to use in patients with heart failure?

Semaglutide (Ozempic) in Heart Failure

Semaglutide (Ozempic) is safe and beneficial to use in patients with heart failure, particularly in those with preserved ejection fraction (HFpEF), as it reduces heart failure events and improves symptoms.

Safety and Benefits by Heart Failure Type

Heart Failure with Preserved Ejection Fraction (HFpEF)

• Semaglutide has shown significant benefits in patients with HFpEF:
  • Improves heart failure-related symptoms and physical limitations 1
  • Reduces weight by approximately 10% (vs 3.4% with placebo) 1
  • Reduces the risk of heart failure events by 25-41% 2, 3
  • Benefits are consistent regardless of baseline HbA1c levels 4

Heart Failure with Reduced Ejection Fraction (HFrEF)

• Semaglutide has shown benefits in HFrEF patients as well:
  • Reduces MACE (major adverse cardiovascular events) with HR 0.65 3
  • Reduces composite heart failure endpoints with HR 0.79 3

Mechanism and Comparative Benefits

• GLP-1 receptor agonists like semaglutide reduce the risk of atherosclerotic major adverse cardiovascular events 5
• Unlike some other diabetes medications:
  • No increased risk of heart failure hospitalization has been identified with GLP-1 receptor agonists including semaglutide 5
  • This contrasts with thiazolidinediones which have a strong relationship with increased heart failure risk and should be avoided 5
  • Also differs from some DPP-4 inhibitors (particularly saxagliptin) which may increase heart failure hospitalization risk 5

Evidence from Recent Clinical Trials

• The STEP-HFpEF DM trial (2024) showed that in patients with obesity-related HFpEF and type 2 diabetes, semaglutide:

  • Improved Kansas City Cardiomyopathy Questionnaire scores by 13.7 points vs 6.4 points with placebo 1
  • Improved 6-minute walk distance by 14.3m more than placebo 1
  • Reduced C-reactive protein levels 1
  • Had fewer serious adverse events (17.7%) compared to placebo (28.8%) 1

• A 2024 pooled analysis of four randomized trials (SELECT, FLOW, STEP-HFpEF, and STEP-HFpEF DM) showed semaglutide:

  • Reduced the composite of cardiovascular death or heart failure events by 31% 2
  • Reduced worsening heart failure events by 41% 2

Special Populations

• In patients with type 2 diabetes and chronic kidney disease (high-risk for heart failure):
  • Semaglutide reduced heart failure events by 27% 6
  • Benefits were consistent regardless of history of heart failure 6

Practical Considerations

• Semaglutide is particularly beneficial in patients with:

  • Obesity-related heart failure
  • Type 2 diabetes with heart failure
  • Heart failure with preserved ejection fraction

• Dosing:

  • For heart failure studies, doses of 2.4mg weekly were typically used 1, 2, 3
  • In chronic kidney disease patients, 1.0mg weekly was effective 6

Common Pitfalls to Avoid

• Don't confuse GLP-1 receptor agonists like semaglutide with:

  • Thiazolidinediones (contraindicated in heart failure) 5
  • DPP-4 inhibitors (some may increase heart failure risk) 5

• Monitor for:

  • Gastrointestinal side effects (common with semaglutide)
  • Hypoglycemia risk (though rates were actually lower than placebo in some studies) 4

In conclusion, semaglutide represents a safe and potentially beneficial option for patients with heart failure, particularly those with preserved ejection fraction, obesity, and/or type 2 diabetes.