Glucagon-Like Peptide-1 Receptor Agonists Versus Bariatric Surgery in Patients With Obesity and Heart Failure With Preserved Ejection Fraction.

BACKGROUND: To compare the effectiveness of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) versus bariatric surgery on cardiovascular outcomes in patients with heart failure (HF) with preserved ejection fraction and obesity. METHODS: Using the TriNetX research network, we conducted a retrospective cohort study of adults (aged ≥18 years) with HF with preserved ejection fraction and obesity (body mass index >30 kg/m) from 2017 to 2022. Patients were categorized into 2 cohorts: those receiving GLP-1 RAs (semaglutide or tirzepatide) and those who underwent bariatric surgery. Propensity score matching (1:1) was used to balance baseline characteristics. Primary outcomes included acute HF events and all-cause hospitalizations. Secondary outcomes included all-cause death, myocardial infarction, stroke, and follow-up body mass index. Cox proportional hazard models were used to estimate hazard ratios (HRs). RESULTS: A total of 2747 patients were included per cohort (mean age, 68 years). GLP-1 RA therapy was associated with lower incidence of acute HF events (38.9% versus 44.6%; HR, 0.78 [95% CI, 0.72-0.85]), all-cause death (11.1% versus 14.8%; HR, 0.71 [95% CI, 0.61-0.82]), and all-cause hospitalizations (66.4% versus 77.3%; HR, 0.62 [95% CI, 0.58-0.66]). Rates of myocardial infarction (13.8% versus 13.4%; HR 0.99 [0.86-1.14]) and stroke (9.7% versus 10.7%; HR, 0.87 [0.74-1.02]) were similar between groups. Mean body mass index at follow-up was 38.0 in the GLP-1 RA cohort versus 37.7 after bariatric surgery (=0.34). Hemoglobin Aat follow-up was higher in the GLP-1 RA group (7.4 versus 6.8;<0.001). CONCLUSIONS: In patients with HF with preserved ejection fraction and obesity, GLP-1 RA therapy was associated with improved outcomes compared with bariatric surgery, supporting the need for prospective trials to evaluate GLP-1 RAs as a therapeutic alternative.