Oral Semaglutide Reduces BNP, Improves Cardiac Structure, and Glycemic Control in HFpEF Patients with T2DM

Heart failure with preserved ejection fraction (HFpEF) is a complex syndrome characterized by stiff heart muscles, leading to impaired relaxation and filling, often co-occurring with type 2 diabetes mellitus (T2DM). Current therapies for HFpEF primarily manage symptoms, and there's a significant gap in treatments that directly improve cardiac structure or function, especially in diabetic patients. The role of GLP-1 receptor agonists like semaglutide, known for their metabolic benefits, on cardiac biomarkers such as B-type natriuretic peptide (BNP) and cardiac remodeling in this specific patient population has remained largely unexplored in real-world settings. This study addresses that clarity gap.

Researchers retrospectively analyzed 27 patients with HFpEF and T2DM who initiated oral semaglutide at a single academic center. Clinical data were collected at three time points: three months before treatment (pre-treatment), at initiation (baseline), and three months after oral semaglutide initiation (on-treatment). The primary outcome measured was the change in the common logarithm of BNP levels (log BNP). Secondary outcomes included HbA1c, body weight, C-reactive protein, left atrial volume index, and left ventricular mass index.

Log BNP levels remained stable during the pre-treatment period (p = 0.34) but significantly decreased during the on-treatment period (p < 0.001).

The reduction in log BNP during the three-month on-treatment period was significantly greater than during the pre-treatment period, showing a mean difference of -0.35 (95% confidence interval -0.44 to -0.11, p < 0.001). Concomitant and significant reductions were observed across several key metabolic and cardiac parameters. Patients experienced improvements in HbA1c, body weight, and C-reactive protein levels, indicating better glycemic control and reduced systemic inflammation. Furthermore, cardiac structural benefits were evident with reductions in left atrial volume index and left ventricular mass index. A significant correlation was found between changes in C-reactive protein levels and log BNP (r = 0.46, p = 0.015), suggesting a potential link between reduced inflammation and improved cardiac stress.