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Data extraction was conducted by one reviewer and revised by one coauthor

In a pooled analysis of clinical trials assessing patients with heart failure with preserved ejection fraction (HFpEF), including the STEP HFpEF and STEP HFpEF DM trials, as well as in the FLOW and SELECT trials, semaglutide improved New York Heart Association (NYHA) class IIIV symptoms, physical limitations, exercise function, associated with a 30% reduction of N-terminal pro-brain natriuretic peptide and a 31% reduction in the composite endpoint of cardiovascular death and the need for treatment intensification or hospitalization for heart failure-related events (HR 0.69

Weight loss induced by lifestyle interventions or GLP-1RAs reduces circulating leptin and increases adiponectin, shifting the immune balance toward greater Treg activity and reduced Th1/Th17 responses [36,37]