STEP: Heart Failure in Obesity & Diabetes

Dr. Tashko summarizes the STEP study, highlighting semaglutide's heart failure benefits in patients with obesity and diabetes.

April 2024 NEJM

Background – Diabetologist and Weight Loss Specialist in the State of Maryland

As a board-certified diabetologist and weight loss specialist with clinical and research training, I’m committed to staying abreast of the latest advancements to offer my community optimal care through personalized and integrative approaches.

Conveniently located in Rockville, my practice offers virtual and in-person services, extending support to nearby areas such as Chevy Chase, Bethesda, North Bethesda, Potomac, North Potomac, Gaithersburg, Germantown, Frederick, Silver Spring, Northern Virginia, Howard County, Anne Arundel, and the Eastern Shore of Maryland, ensuring comprehensive care.

Here, I present a summary of the STEP study, demonstrating the heart failure benefits of semaglutide in patients with obesity and diabetes. Let’s dive into the key findings and results published in the New England Journal of Medicine in April 2024.

STEP Study Details and Results

The STEP trial evaluated the effects of semaglutide (Ozempic or Wegovy) 2.4 mg weekly in participants with heart failure, obesity (BMI ≥30), and type 2 diabetes. Patients received either semaglutide or placebo for 52 weeks.

The primary endpoints were changes in Kansas City Cardiomyopathy Questionnaire (KCCQ) scores and body weight. Semaglutide significantly improved KCCQ scores (+14 vs. +6 with placebo) and led to weight loss (-10% vs. -3% with placebo).

Secondary outcomes, such as increased 6-minute walk distance and reduced CRP levels, also favored semaglutide. Serious adverse events occurred less frequently with semaglutide (18%) than with placebo (28%).

The trial lasted approximately 52 weeks. Baseline characteristics included:

  • Number of patients per arm: 300
  • Age: 69 years
  • Male: 60%
  • Caucasian: 80%
  • BMI: 37
  • Bnp: 500 pg/mL
  • Crp: 3.5 mg/L
  • Diabetes duration: 8 years
  • A1c: 6.8%
  • LVEF: 58%
  • KCCQ-CSS: 60%
  • 6 min Walk Distance: 280 meters
  • 1Y HF hospitalization: 55 
  • NYHA II: 70%
  • NYHA III, IV: 30%
  • Hypertension: 80%
  • A Fib: 40%
  • Diuretic: 80%
  • Loop Diuretic: 60%
  • Thiazide: 15%
  • ACEi, ARB, ARNI: 80%
  • MRA: 35%
  • BB: 80%
  • SGLT2i: 35%

Semaglutide benefits obesity-related heart failure in type 2 diabetes, improving symptoms and aiding weight loss.

Dr. Tashko