Heart failure does not mean the heart has stopped. It means the heart cannot pump blood as well as the body needs. People with it often feel tired and short of breath.

Many people with heart failure also live with type 2 diabetes or extra body weight. Together, these problems can put even more strain on the heart. That is why heart failure medicines matter to the Dibesity community.

One of these medicines is vericiguat, sold as Verquvo. It is a pill taken once a day. Since 2025 it has been back in the news, and the story is more mixed than the headlines suggest.

This article explains what the research shows and what it does not show. It also covers who needs to be careful with this drug. It is for education only and is not medical advice.

Why Is Vericiguat in the News Now?

Three events brought vericiguat back into focus.

First, in August 2025, researchers shared the results of a large trial called VICTOR. They presented it at a major European heart meeting and published it in The Lancet. The trial tested vericiguat in people whose heart failure was stable.

Second, in January 2026, the US drug label for Verquvo was updated. The change was in the dosing section. Your doctor decides the starting dose and how fast to raise it.

Third, in August 2026, the European Society of Cardiology released new heart failure guidelines. Summaries say vericiguat kept a Class IIb rating. This rating means doctors may consider the drug, but the evidence is not strong enough to make it a first choice.

Those summaries also say the advice is no longer limited to people whose heart failure recently got worse. The new guidelines also add a first-time recommendation for GLP-1-based medicines in people with obesity and a different type of heart failure. That other type is not the focus of this article.

A Quick Word About This Type of Heart Failure

Vericiguat is approved for heart failure with reduced ejection fraction, or HFrEF. Ejection fraction (EF) is the share of blood the heart pushes out with each beat. In the US, the label covers adults who have symptoms and an EF below 45%.

Doctors use four main groups of medicines as the base for HFrEF. These include beta-blockers, ACE inhibitors and similar drugs, MRAs, and SGLT2 inhibitors. You do not need to memorize these names.

SGLT2 inhibitors were first made for diabetes. So this field already links to metabolic health. Vericiguat is not one of the four base medicines. It is an add-on.

Vericiguat works on a signal path that helps blood vessels relax. The signal chemical is called cGMP. This path is weaker in HFrEF, and vericiguat helps turn it up. Before vericiguat, no heart failure medicine targeted this path.

What the Latest Research Says

The first big trial: VICTORIA

VICTORIA enrolled 5,050 adults whose heart failure had recently gotten worse. That meant a hospital stay in the past 6 months or IV water pills in the past 3 months. Everyone was already getting standard care.

People were picked by chance to get vericiguat or a dummy pill, called a placebo. Both groups were followed for about 11 months.

In the vericiguat group, 35.5% had a heart-related death or a first hospital stay for heart failure. In the placebo group, 38.5% did. That is about 3 fewer people for every 100 treated, or roughly a 10% lower risk.

The gain was real but modest. Heart-related deaths on their own did not differ clearly between the groups. One heart specialist who was not part of the trial called the benefit modest, but welcome for a group with few options.

Based on this trial, the FDA approved Verquvo in January 2021. It was the first drug of its type approved for heart failure.

Evidence check: This is established evidence for the group studied. It came from a large, well-designed trial. But it cannot tell us what happens in people who are more stable.

The second big trial: VICTOR

VICTOR asked a new question. Does vericiguat help people whose heart failure is stable?

The trial enrolled 6,105 people. The typical age was 68, and about 24% were women. Nearly half had never been in the hospital for heart failure.

These people were also well treated. Almost all took a beta-blocker. About 60% took an SGLT2 inhibitor, and nearly 80% took an MRA. They were followed for about a year and a half.

The main goal was a heart-related death or a hospital stay for heart failure. It happened in 18.0% of the vericiguat group and 19.1% of the placebo group. That gap was small enough to be due to chance. So the trial missed its main goal.

But a few other results stood out. Heart-related deaths were lower with vericiguat: 9.6% versus 11.3%. That is roughly 2 fewer deaths for every 100 people. Deaths from any cause were also lower: 12.3% versus 14.4%.

Hospital stays for heart failure did not drop. That surprised experts, because deaths and hospital stays usually move together in heart failure trials. Some called the pattern puzzling.

Now the caution. When a trial misses its main goal, doctors treat the other results as hints, not proof. The trial also had only about 690 hospital stays, which made differences hard to see.

Researchers then counted a wider set of worsening events, such as urgent clinic visits. The result was borderline. It showed about a 10% lower risk, with a range that just touched no effect.

Evidence check: This is emerging evidence. The main goal was missed, and the mismatch between deaths and hospital stays is not explained.

Putting the two trials together

The researchers had planned a combined analysis of both trials. It covered 11,155 people with a wide range of illness severity. In this pooled look, vericiguat was linked with a 9% lower risk of the main outcome.

Heart-related deaths were 11% lower, and first hospital stays were 8% lower. Deaths from any cause were 10% lower.

A blood test called NT-proBNP shows how much stress the heart is under. People with levels at or below 6,000 seemed to get a bigger benefit. That was the only group difference that stood out in the pooled data. Earlier data suggested that people with very high levels did not benefit.

Both trials were paid for by the drug makers, Merck and Bayer. Several lead researchers report ties to them. That does not make the results wrong. It is a reason to read them with care.

Evidence check: This is emerging evidence. Combining two trials with different kinds of patients can hide differences.

What It Means for Obesity, Diabetes, and Metabolic Health

Type 2 diabetes makes heart failure outcomes worse. Many people in these trials had it. In a look-back analysis of VICTORIA, about 62% of the 3,683 people with blood sugar test data had type 2 diabetes. Another 20% had prediabetes.

The benefit looked similar whether or not people had diabetes. But researchers asked this question after the trial ended. Treat it as a hint, not proof. Some groups were also small, so the numbers are uncertain.

Real life may differ from a trial. In a Spanish registry of people given vericiguat, patients were older than those in VICTORIA. They also had more diabetes and more kidney problems. About 20% had very low kidney function.

A registry only watches what happens. It cannot tell us whether the drug helped those patients. It does warn us that trial results may not carry over fully.

Vericiguat is not a diabetes drug or a weight-loss drug. It has not been tested for either job. Its job is to lower the risk of heart failure events in certain people.

The bigger lesson is about how closely body systems are linked. Diabetes medicines called SGLT2 inhibitors are now part of base care for heart failure. New guidelines also add GLP-1-based medicines for obesity with one type of heart failure. Heart health, blood sugar, and weight go together.

What This Means in Real Life

Vericiguat is an add-on, not a replacement. In both trials, people took it on top of their usual heart failure medicines.

The strongest evidence is for people whose heart failure recently got worse. That is also the group the US label names. For stable people, a review from the American College of Cardiology said routine use is not yet backed by VICTOR’s main result. It said the choice should be made case by case, after weighing benefits and risks.

Practical issues matter too. One US heart specialist said that adding a fifth medicine is a hard sell. He pointed to cost and to how willing people are to take more pills.

A lead VICTOR researcher takes a stronger view and supports using the drug widely. Experts clearly disagree. That is a sign the science is still moving.

What We Know

• Vericiguat works on the cGMP path, which is different from the path other heart failure medicines use.
• In people with a recent worsening, one large trial found about a 10% lower risk of a heart-related death or hospital stay.
• In stable people, VICTOR missed its main goal.
• Combined, the two trials point to a modest overall benefit.
• In VICTORIA, low blood pressure and anemia were the most common side effects.
• It must not be used during pregnancy.

What We Don’t Know

• Why heart-related deaths fell in VICTOR when hospital stays did not.
• Whether the benefit in stable people is real or a chance finding.
• Which people get the most benefit. The blood test result is only a hint so far.
• How the drug performs over many years. The trials followed people for about 11 and 18 months.
• Whether results hold in older, sicker people seen in everyday care.
• How cost and the number of pills affect whether people keep taking it.

Common Misconceptions

“The VICTOR trial failed, so the drug does not work.”

Not quite. The main goal was missed in stable people. But fewer heart-related deaths were seen, and the combined data point to a small benefit. The honest summary is that the picture is uncertain, with a possible modest benefit.

“It is a cure for heart failure.”

No. In the trials, it lowered the average risk of bad events in some people. It does not cure heart failure.

“It replaces the other heart medicines.”

No. It is used on top of them. Never stop or change a heart medicine on your own.

“It is a diabetes or weight-loss pill.”

No. It was not designed or tested for either use.

Who Should Be Especially Careful

The US label carries a boxed warning, its strongest kind. It says the drug must not be used in pregnancy because it may harm an unborn baby. Pregnancy should be ruled out before treatment starts.

People who could become pregnant are told to use effective birth control during treatment. They are also told to keep using it for at least one month after the last dose. Breastfeeding is not recommended.

Other points from the label matter too:

• Low blood pressure was among the most common side effects. Doctors may start with a lower strength in people at risk.
• Anemia, which means low red blood cells, was more common than with placebo (10% versus 7%).
• Verquvo must not be combined with other drugs of the same type.
• Pills for erectile dysfunction, called PDE-5 inhibitors, are not recommended with it. The reason is the risk of low blood pressure.

Practical, Evidence-Based Steps

• If you or a loved one has HFrEF, ask your doctor whether you have had a recent worsening event. That is the group with the strongest evidence.
• Because the benefit is modest, talk about your goals. Ask what the drug may do for you and what it adds to your daily routine.
• Share a full list of everything you take. Include supplements and any pills for erectile dysfunction.
• Tell your doctor early about any pregnancy plans.
• Work with your care team on blood sugar, blood pressure, and weight. These all affect the heart.
• Do not stop or change any heart medicine on your own.
• If your symptoms suddenly get worse, call your doctor or emergency services.

Frequently Asked Questions

What is vericiguat used for?

In the US, it is approved to lower the risk of heart-related death and heart failure hospital stays. It is for adults with symptoms, an EF below 45%, and a recent hospital stay or IV water pills.

How does Verquvo work?

It turns up the cGMP signal path, which helps blood vessels relax. This is a different path from the one other heart failure medicines use.

Is it a first-choice medicine?

No. Guidelines give it a Class IIb rating. That means doctors may consider it, usually on top of the base medicines.

Does it work for people with diabetes?

A look-back analysis of VICTORIA found a similar benefit with or without diabetes. It was not a planned test, so more data is needed.

What are the common side effects?

In VICTORIA, low blood pressure and anemia were the most common. Low blood pressure was about as common as with placebo. Anemia was somewhat more common.

Can women who may become pregnant take it?

It must not be used during pregnancy. Pregnancy should be ruled out first, and effective birth control is needed during treatment.

Conclusion

A drug can have a real but modest benefit and still be the wrong fit for some people. That is the lesson of vericiguat. The first trial found a gain in people with worsening heart failure. The second trial left more questions than answers.

If you have heart failure, bring your full medicine list to your next visit. Ask whether you belong to the group with the strongest evidence. Your heart, blood sugar, and weight all work together, so plan your care as a team.

This article is for education. It does not diagnose or treat any condition, and it cannot replace advice from your own doctor.

References

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12. Heidenreich PA, Bozkurt B, Aguilar D, et al. 2022 AHA/ACC/HFSA guideline for the management of heart failure. Circulation. 2022;145(18):e895-e1032. [Ref]
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