Dear Dr. Roach: My 66-year-old husband recently received a diagnosis of heart failure with preserved ejection fraction. He is 5 feet, 7 inches tall, and weighs 270 pounds. He is treating his fluid retention with 100 mg of furosemide daily. He also has mild, untreated sleep apnea.

He would like to try one of the GLP-1 drugs to lose some weight, but I am concerned about possible pancreatitis due to his alcohol consumption. (He drinks 6-7 whiskeys a day.) My primary care physician told me that some people get very sick if they drink alcohol while taking this medication.

On this evening’s newscast, there was a story about some people having success with combatting alcohol addiction while using these drugs, and we had also heard they help with sleep apnea. In your opinion, would it be beneficial and safe for him to try one?

— B.V.

Answer: Heart failure is a reduced ability of the heart to provide all of the blood that the body needs, while maintaining low pressures in the heart to let the blood from the lungs properly drain. Heart failure with preserved ejection fraction (HFpEF) means that the heart is able to squeeze properly, but its main problem is relaxing at a low pressure. The high-filling pressures cause a fluid backup, leading to volume overload (also called fluid retention).

While furosemide and other diuretics can help with symptoms, the drugs that have had a very significant impact on the management of HFpEF have been drugs that were initially used for diabetes, SGLT2 inhibitors such as empagliflozin, and GLP-1 agonists such as semaglutide (in people with both HFpEF and obesity). These drugs help people lose weight and have also been shown to reduce hospitalization for heart failure.

Pancreatitis has been reported in people taking GLP-1 drugs. However, the risk is low, approximately 1 per 1,000 people taking the drug for a year. It is not even certain yet that the risk of pancreatitis is higher with these drugs compared to other classes of drugs. Nonetheless, I am hesitant to use these in a person with a history of pancreatitis. I would stop and never restart a GLP-1 drug if pancreatitis develops during treatment.

There are early and suggestive data that GLP-1 drugs reduce alcohol cravings. A large cohort of people with alcohol use disorder taking semaglutide or liraglutide had a decreased risk of hospitalization for alcohol or other substance use.

A different study showed decreased alcohol use during treatment with semaglutide or tirzepatide. These results have not been confirmed with a randomized clinical trial, but experts are optimistic. Alcohol in the amount that he is taking is toxic to the heart, although alcohol-related heart failure typically happens with reduced ejection fraction, not preserved.

Given your husband’s severe obesity (a BMI of 42.3 is severe), the benefit of a GLP-1 agent on his weight, heart failure and alcohol use greatly outweighs the potential harm from pancreatitis. Finally, there are now strong data to show that in people with sleep apnea and obesity, treatment with a GLP-1 agent can reduce sleep apnea.

Severe untreated sleep apnea is a cause for heart failure. Charles Dickens knew this back in 1836 and wrote a very clear description in his first novel, “The Posthumous Papers of the Pickwick Club.”

Contact Dr. Roach at ToYourGoodHealth@med.cornell.edu.