The World Health Organization on Dec. 1 issued a guideline recommending the use of GLP-1s for the treatment of obesity in adults.
The WHO guideline recommends long-term use of at least six months alongside intensive behavioral therapy.
Recognizing individuals with obesity are at higher risk of developing heart failure, Kevin Shah, MD, and Andrew Yoon, MD — who co-lead the heart failure program at Fountain Valley, Calif.-based MemorialCare’s Heart & Vascular Institute at the Long Beach (Calif.) Medical Center — saw an opportunity to support their patients.
Dr. Shah and Dr. Yoon serve as the heart failure program’s director of outreach and medical director, respectively. They shared with Becker’s how they’ve integrated GLP-1s into treatment of heart failure with preserved ejection fraction, and a pathway to broader adoption among cardiologists.
Editor’s note: Responses have been lightly edited for clarity and length.
Question: What led the MemorialCare Long Beach team to adopt the use of GLP-1 medications to treat HFpEF ahead of most health systems?
Dr. Kevin Shah: We follow the evidence closely. The STEP-HFpEF and SUMMIT trials showed compelling results, not just symptom improvement but meaningful reductions in heart failure events. We recognize these are not just weight loss medications, they are cardiac therapeutics. For our patients with HFpEF and obesity, we integrate GLP-1 agonists alongside other guideline therapies.
Dr. Andrew Yoon: The data detailing the benefits of GLP-1 agonists for HFpEF patients is significant and compelling, especially since the pharmacologic armamentarium for these patients has been historically very limited, so we were proactive in our practice to incorporate this line of medications for the treatment of our eligible HFpEF patients.
Q: While GLP-1s are widely known for treating Type 2 diabetes and obesity, your team is applying them to cardiometabolic care with notable outcomes. Can you share what improvements you’ve seen in patients with obesity-related HFpEF?
KS: We’ve seen significant improvements in the quality of life for our HFpEF patients using these medications. There are fewer hospital visits, increased physical stamina, reduced peripheral edema and a renewed sense of hope in their daily lives. There are patients who, before, struggled just to walk to the mailbox or climb stairs, who now report being able to enjoy family activities and reclaim their independence.
AY: I agree with Kevin. Although the effects vary from patient to patient, I have seen some remarkable improvements in my HFpEF patients.
Q: What barriers or misconceptions do you think still exist regarding the use of GLP-1s in cardiology? What needs to happen to support broader adoption in heart failure care?
KS: The biggest misconception is that these are “just” diabetes drugs or “just” weight loss drugs. Here’s my view: When clinical trials study cardiovascular outcomes and show reductions in heart failure events, they become cardiac drugs. The practical barriers are cost and access. These medications are expensive and insurance often will not cover them depending on the indication.
From a regulation perspective, we need FDA indications based on the randomized trial evidence to clarify coverage and encourage adoption. From an education perspective, we need to update our colleagues and educate our cardiology fellow trainees about which patients may derive the most benefit from which drug.
AY: I suspect some clinicians shy away from prescribing GLP-1 agonists because they assume it’s the territory of primary care or endocrinology, likely because the public conversation frames them as weight-loss drugs. But the cardiac benefits are real and independent of weight loss or glucose control. HFpEF can be hard to diagnose, and the suffering is real, so cardiologists should not hesitate to start these medications when appropriate. That said, I do ask my primary care or endocrinology colleagues to initiate and monitor therapy for patients with insulin-dependent diabetes.
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