STEP-HFpEF: semaglutide in heart failure with preserved EF — March 2026

Clinical perspective, offered as context rather than as advice.

Cardiac biomarkers and cardiovascular risk: my cardiologist ordered advanced cardiac labs given my family history. Results were encouraging:

• NT-proBNP: 47 pg/mL (normal, cardiac function preserved)
• Lp(a): 57 nmol/L (genetic, unchanged — expected)
• ApoB: dropped from 152 to 87 mg/dL (excellent response)
• Coronary calcium score: 0 (unchanged from baseline — reassuring)

The ApoB reduction is particularly meaningful — it's considered the best single predictor of cardiovascular risk. GLP-1 therapy seems to improve this consistently.

andrew_nyc said:

Cardiac biomarkers and cardiovascular risk: my cardiologist ordered advanced cardiac labs given my family history.

Same experience, arrived at from the opposite direction. I had assumed I was the exception until I read this.

andrew_nyc said:

Cardiac biomarkers and cardiovascular risk: my cardiologist ordered advanced cardiac labs given my family history.

There is a second half to this that has not been said yet. The mechanism that matters here is not stomach emptying, it is central. GLP-1 receptor agonism in the arcuate nucleus stimulates POMC neurons and suppresses AgRP/NPY signalling, which is why the effect is appetite and food salience rather than physical fullness. Delayed gastric emptying largely tachyphylaxes over the first months; the appetite effect does not.

andrew_nyc said:

Cardiac biomarkers and cardiovascular risk: my cardiologist ordered advanced cardiac labs given my family history.

CRP reduction on cardiovascular risk — this is the lab result that excites me most:

Baseline hsCRP: 9.0 mg/L (high cardiovascular risk)
Month 6 hsCRP: 2.5 mg/L (moderate risk)
Month 12 hsCRP: 0.4 mg/L (low risk)

This level of inflammatory marker reduction is comparable to what you'd see with statin therapy. Combined with the weight loss, my 10-year ASCVD risk score dropped from 16% to 5%. My cardiologist is genuinely impressed.

Closing the loop on my own question.

Update since I posted: I held at 1.7mg for a further twelve weeks and lost another 4kg slowly, which settles it for me. I was escalating because the number was available, not because I had stopped responding.