Body mass index-dependent therapeutic efficacy in HFmrEF and HFpEF: A systematic review and network meta-analysis
Abstract
Several pharmacological classes have demonstrated favorable impacts on cardiovascular outcomes in patients with heart failure (HF) with preserved ejection fraction (HFpEF) and HF with mildly reduced ejection fraction (HFmrEF). Given the ubiquitous presence of obesity in HFmrEF and HFpEF, this study aimed to assess the cardiovascular benefits of principal heart failure drug classes according to body mass index (BMI) strata.
A systematic search of the bibliographic databases (PubMed, Cochrane Library, and Embase) was conducted to identify randomized clinical trials published between January 2000 and January 2025, with no language restrictions. The study eligibility was restricted to peer-reviewed articles and randomized clinical trials. A systematic search of major electronic databases was conducted to identify studies comparing key drug classes, such as semaglutide, tirzepatide, finerenone, empagliflozin, dapagliflozin, and spironolactone. The primary endpoint was defined as a composite endpoint comprising cardiovascular death and heart failure hospitalizations. We employed Mendelian randomization to investigate the causal effects of glucagon-like peptide-1 receptor agonist activity on HFmrEF and HFpEF. The study protocol was prospectively registered with PROSPERO (registration ID: CRD420251022550).
Our search identified six eligible trials, encompassing a total of 33,524 patients for the pooled analysis, the majority of whom had HFpEF. In a network meta-analysis of patients…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 33,524 participants or records.
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