STEP-HFpEF Semaglutide — EECC MCQ
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Correct answer: A — STEP-HFpEF showed semaglutide 2.4 mg weekly improved symptoms (KCCQ score), exercise capacity (6MWD), reduced body weight (~13%), and decreased CRP in obese HFpEF patients WITHOUT diabetes — establishing GLP-1 RA as a disease-modifying therapy for the obesity-HFpEF phenotype
STEP-HFpEF (2023) was a landmark trial: 529 obese patients (BMI ≥30) with HFpEF (LVEF ≥45%) WITHOUT diabetes randomised to semaglutide 2.4 mg SC weekly vs placebo for 52 weeks. Results: (1) KCCQ-CSS improvement +7.8 points (clinically meaningful); (2) 6MWD increase +20 m; (3) body weight reduction ~13%; (4) CRP reduction ~40%; (5) NT-proBNP reduction. STEP-HFpEF-DM (2024) confirmed similar benefits in diabetic obese HFpEF. These trials established that: (1) obesity is not merely a comorbidity but a direct driver of HFpEF pathophysiology; (2) weight loss with GLP-1 RA provides disease-modifying benefit beyond simply treating a risk factor; (3) the mechanism involves: reduced epicardial fat, improved diastolic function, anti-inflammatory effects, and improved metabolic health. The SELECT trial additionally showed semaglutide reduces MACE in obese non-diabetic patients. GLP-1 RAs are emerging as a pillar of obesity-HFpEF management.
Reference: ESC (2023): HF; STEP-HFpEF Trial