4 March, 2026

Obesity and heart failure: what changes with the new European indication for tirzepatide

March 4, World Obesity Day, is an opportunity to remember that obesity is not an aesthetic issue but a complex chronic disease with a direct impact on metabolic and cardiovascular health. In this context, the recent extension of the European indication for tirzepatide —the active ingredient of Mounjaro— in patients with obesity and heart failure opens a new therapeutic scenario.

To understand what this change really means, we spoke with Dr. Jesús Blanco, endocrinologist at barnaclínic+ and the Hospital Clínic of Barcelona, and with Dr. Pedro Caravaca, cardiologist specializing in heart failure at the Hospital Clínic of Barcelona. Both agree on a key point: obesity must now be addressed as a chronic inflammatory disease with systemic consequences, especially for the heart.

At barnaclínic+, we offer a comprehensive approach to obesity that includes the different therapeutic options currently available —from personalized pharmacological treatment to endoscopy or bariatric surgery— as well as specialized evaluation and follow-up for heart failure. Coordination between endocrinology and cardiology allows us to treat not only body weight but also the overall cardiometabolic risk of each patient.

Obesity: a chronic, complex and systemic disease

Far from being an aesthetic issue, obesity is a chronic, progressive and multifactorial disease that directly affects key organs such as the heart. “Obesity, understood in current terms, must be considered a chronic, complex and progressive disease over time,” explains Dr. Jesús Blanco. For years, its management was reduced to general recommendations about diet and exercise. However, we now know that dysfunctional adipose tissue generates systemic inflammation, insulin resistance and hemodynamic alterations that favor the development of heart failure.

“It is not simply a matter of habits. There is a medical component behind a person who has been struggling with their weight for a long time.”

Dr. Pedro Caravaca, cardiologist specializing in heart failure

This is why current treatment requires a full clinical evaluation, assessment of comorbidities and, when indicated, the incorporation of obesity medications, selected individually according to the patient’s clinical profile, the presence of type 2 diabetes, cardiovascular risk and therapeutic goals.

What is tirzepatide and what it brings to obesity treatment

Tirzepatide, whose brand name is Mounjaro, is a dual agonist of the GIP and GLP-1 receptors that works by modulating appetite, increasing satiety and improving glucose metabolism.

It differs from Wegovy (semaglutide) because tirzepatide acts on both the GLP-1 receptor and the GIP receptor, while semaglutide acts only on GLP-1. Both are among the latest obesity medications with high clinical efficacy.

“99.9% of the prescriptions we currently make in consultation are divided between tirzepatide and semaglutide.”

Dr. Jesús Blanco, endocrinologist

These drugs can be prescribed in people with a BMI above 30, or above 27 if associated conditions such as type 2 diabetes or cardiovascular disease are present. But the key factor is not only BMI. “Any patient with excess adiposity is potentially a candidate to benefit from these treatments.” According to Dr. Caravaca, we are currently experiencing “a very favorable moment” in the treatment of obesity and heart failure.

Obesity and heart failure: inflammation and a new therapeutic approach

The link between obesity, heart failure and inflammation is now undeniable. For years, the so-called “J-curve” of body weight in heart failure was discussed. However, when we analyze the real excess of adiposity —beyond the number on the scale— the relationship becomes linear: the greater the body fat, the higher the cardiovascular risk.

“Obesity is one of the drivers that modulates the development and progression of heart failure.”

Dr. Jesús Blanco, endocrinologist

For years, the so-called “J-curve” of body weight in heart failure was discussed. However, when we analyze the real excess of adiposity —beyond the number on the scale— the relationship becomes linear: the greater the body fat, the higher the cardiovascular risk.

Especially in heart failure with preserved ejection fraction, the problem is not so much the strength of the heart but stiffness and increased filling pressures.

This explains why treating adiposity can become a key component of heart failure management. As Dr. Blanco points out, “With the new obesity treatments, we have incorporated a new therapeutic arsenal that improves patients’ clinical evolution and reduces the occurrence of clinical events.”

In heart failure we rarely speak about definitive cure. However, we now know that it is possible to live with heart failure and to live many years with heart failure when it is addressed comprehensively, acting on all the physiopathological axes involved —including the metabolic inflammation associated with obesity— and optimizing each component of treatment in a personalized way.

In certain profiles, tirzepatide may act as a true heart failure drug when obesity is a central modulating factor.

Safety and monitoring: keys to success

The most common side effects of tirzepatide are digestive: nausea, a feeling of fullness, slower digestion or constipation, especially when dose escalation occurs too quickly. In most cases, these are temporary and manageable symptoms within appropriate medical follow-up. As Dr. Blanco explains: “Part of the medical approach is to minimize and individualize doses for each patient in order to achieve the lowest possible incidence of side effects.”

The key lies in personalization and gradual treatment adjustment. In patients with heart failure, it may also be necessary to review diuretic therapy, since these drugs can add a mild additional diuretic effect.

“These are very safe drugs and with small adjustments it is rarely necessary to discontinue the medication.”

Dr. Pedro Caravaca, cardiologist specializing in heart failure

We are not talking about isolated solutions or one-off interventions, but about effective therapeutic tools that, integrated into a structured multidisciplinary plan, help optimize both outcomes and long-term safety.

Comprehensive treatment at barnaclínic+

Obesity is a chronic disease that requires a multidisciplinary approach. At barnaclínic+ we offer:

• Personalized pharmacological treatment.

• Structured weight-loss programs.

• Endoscopic techniques for selected patients.

• Bariatric surgery in indicated cases.

• Specialized evaluation and treatment of heart failure.

• Direct coordination between endocrinology and cardiology.

The objective is not only weight reduction, but also lowering cardiovascular risk, improving quality of life and optimizing prognosis.

The new European indication for tirzepatide reinforces a clear message: obesity treatment has evolved. Today we speak about personalized medicine, cardiometabolic risk control and early intervention based on scientific evidence.

Watch the full interview

We invite you to watch the interview with Dr. Jesús Blanco and Dr. Pedro Caravaca to learn more about what Mounjaro is, how tirzepatide works and its role in obesity and heart failure.

If you would like a personalized evaluation, you can request an appointment with our multidisciplinary team to determine which therapeutic option is most appropriate in your case.