Endocrine Abstracts

Background: The demand for GLP-1 receptor agonists is placing huge strain on under-resourced NHS services. There is increasing evidence of health benefits independent of weight loss, with Semaglutide (Wegovy 2.4 mg) now also licensed for patients with BMI≥27 kg/m² and previous cardiovascular disease, with NICE recommendations expected soon.

Case: We present a 31-year-old male with hypertrophic cardiomyopathy (HCM) diagnosed in 2018 and obesity (weight 155 kg, BMI 45 kg/m²). The patient experienced severe symptoms such as shortness of breath, fatigue and decreased exercise tolerance, particularly postprandially. This can be common in HCM due to an abnormal haemodynamic response to eating, which is exacerbated by exertion. Consequently, the patient only ate one meal daily, triggering periods of extreme exhaustion, negatively impacting his quality of life. His symptoms were unmanaged with available medical therapy, with plans for a myomectomy and the newly approved Mavacamten when available. In June 2024, he was started on Semaglutide, along with diet and lifestyle advice, to support weight loss prior to potential surgery. The dose was titrated up to 2.4 mg over five months. Within a month, the patient noticed his post-prandial symptoms disappeared and his exercise tolerance improved significantly. He established regular meals and weight loss at 1 year was around 9% (weight 140 kg). A repeat echocardiogram showed a reduction in the peak left ventricular outflow tract gradient from 66 mmHg to 29 mmHg at rest, and from 69 mmHg to 41 mmHg following valsalva. This case demonstrates unexpected effects of Wegovy, which are likely independent of weight loss given how quickly the symptoms improved on commencing treatment and the modest fall in weight observed. There was significant improvement in cardiac function and symptoms related to HCM, allowing the patient to avoid surgical intervention.