Dear Dr. Roach: My 66-year-old husband has been diagnosed with heart failure with preserved ejection fraction. He’s 5 feet 7 inches tall and weighs 270 pounds. To manage his fluid retention, he takes 100 mg of furosemide daily. He also has mild sleep apnea that isn’t being treated.
He’s thinking about trying one of the GLP-1 medications to help him lose weight. However, I’m worried about the risk of pancreatitis because he drinks 6-7 whiskey drinks each day. My doctor mentioned that some individuals experience illness when combining alcohol with these medications.
On a recent news segment, I heard about people using these drugs to tackle alcohol addiction, and I’ve also heard they can help with sleep apnea. Do you think it would be safe and helpful for him to try one? — B.V.
Answer: Heart failure can limit the heart’s ability to pump enough blood, leading to fluid buildup. In heart failure with preserved ejection fraction (HFpEF), the heart pumps properly but has trouble relaxing well, causing increased pressure and fluid retention.
While medications like furosemide can ease some symptoms, SGLT2 inhibitors, originally for diabetes, and GLP-1 agonists, like semaglutide, have shown significant benefits for patients with HFpEF, especially those struggling with obesity. These medications promote weight loss and can reduce hospital visits due to heart failure.
Pancreatitis is a possible side effect of GLP-1 medications, but the risk is quite low—about 1 in 1,000 people in a year. It’s unclear if this risk is higher than with other drug classes, but caution is certainly warranted, especially if there’s a history of pancreatitis. If pancreatitis occurs while taking the drug, it should be stopped immediately.
Recent studies suggest that GLP-1 drugs may help reduce alcohol cravings. For example, a group of individuals with alcohol use disorder taking semaglutide or liraglutide had a lower risk of hospitalization for substance issues compared to others. While more research is needed to confirm this, many experts are hopeful about these findings.
Excessive alcohol consumption is harmful to heart health, traditionally linked to heart failure with reduced ejection fraction, but it can affect preserved ejection fraction as well. Given your husband’s severe obesity (his BMI of 42.3 falls into the severe category), the potential benefits of a GLP-1 medication for his weight, heart failure, and even alcohol use may outweigh the risks associated with pancreatitis.
Additionally, studies indicate that GLP-1 agents not only aid weight loss but also significantly improve conditions like sleep apnea, a condition that can contribute to heart failure if left untreated. Notably, Charles Dickens recognized the links between sleep issues and health in his works back in 1836!
Becoming informed about these treatments can truly empower you and your husband on this journey. If you have more questions, a specialist could offer personalized guidance based on his overall health situation.
Dr. Roach regretfully is unable to address individual letters but will weave them into upcoming columns as much as possible. Readers are welcome to email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.
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Source linkHealth,To Your Good Health, Keith Roach, MD
