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Current Atherosclerosis Reports

Erschienen in:

01.01.2021 | Reviews and New Research Implications (S. Virani, Section Editor)

Highlights from Studies Presented at the American Heart Association Scientific Session 2020: Navigating New Roads in Prevention

verfasst von: Aliza Hussain, Mahmoud Al Rifai, Dhruv Mahtta, Jing Liu, Vardhmaan Jain, Salim S. Virani

Erschienen in: Current Atherosclerosis Reports | Ausgabe 1/2021

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Abstract

Purpose of the Review

This review highlights late-breaking science presented at the American Heart Association Scientific Session 2020 that demonstrated advancements in preventative cardiology and introduced novel treatment approaches for the management of chronic kidney disease, type 2 diabetes, and/or heart failure.

Recent Findings

The studies reviewed include clinical trials that assessed the use of omecamtiv in the treatment of heart failure with reduced heart failure (GALACTIC-HF); effects of sotagliflozin in patients with diabetes and recent heart failure exacerbation; cardiovascular outcomes with the use of omega-3 carboxylic acids in patients with high vascular risk and atherogenic dyslipidemia (STRENGTH) and omega-3 fatty acids in elderly patients with recent myocardial infarction (OMEMI); efficacy and safety of evinacumab in patients with refractory hypercholesterolemia; and the use of coronary computed tomography angiography for the assessment of suspected acute coronary syndrome. In addition, we review the results of the International Polycaps Study (TIPS-3) on the use of a polypill for the primary prevention of cardiovascular disease in intermediate-risk people. Finally, we discuss the SAMSON trial—a three-arm-N-of-1 trial—to identify the root cause of the symptoms contributing to patient nonadherence to statin therapy.

Summary

The studies presented at the American Heart Association Scientific Session 2020 represent remarkable contributions in the field of cardiovascular disease and prevention.

1.•

Teerlink JR, Diaz R, Felker GM, McMurray JJV, Metra M, Solomon SD, et al. Cardiac myosin activation with Omecamtiv Mecarbil in systolic heart failure. N Engl J Med. 2020. https://doi.org/10.1056/NEJMoa2025797Randomized controlled trial showing that the primary outcome of cardiovascular death or heart failure was significantly reduced among patients with heart failure with reduced ejection fraction, New York Heart Association (NYHA) functional class II-IV and LVEF ≤35% receiving omecamtiv mecarbil compared to placebo.

2.••

Bhatt DL, Szarek M, Steg PG, Cannon CP, Leiter LA, McGuire DK, et al. Sotagliflozin in Patients with Diabetes and Recent Worsening Heart Failure. N Engl J Med. 2020. https://doi.org/10.1056/NEJMoa2030183In patients with a recent admission with HF and previous diagnosis of T2DM, sotagliflozin, when compared to placebo, significantly reduced rate of primary endpoint (cardiovascular mortality, HF hospitalizations).

3.••

Nicholls SJ, Lincoff AM, Garcia M, Bash D, Ballantyne CM, Barter PJ, et al. Effect of High-Dose Omega-3 Fatty Acids vs Corn Oil on Major Adverse Cardiovascular Events in Patients at High Cardiovascular Risk: The STRENGTH Randomized Clinical Trial. JAMA. 2020. https://doi.org/10.1001/jama.2020.22258In a multi-centric, double-blinded, randomized, placebo-controlled trial of 13,078 patients with either established ASCVD, diabetes or or high-risk primary prevention patients on maximally tolerated statin therapy, use of of omega-3 CA failed to show significant reduction in cardiovascular events among patients with use compared with corn oil.

Kalstad AA, Myhre PL, Laake K, Tveit SH, Schmidt EB, Smith P, et al. Effects of n-3 fatty acid supplements in elderly patients after myocardial infarction. Circulation. 2020. https://doi.org/10.1161/CIRCULATIONAHA.120.052209.

Rosenson RS, Burgess LJ, Ebenbichler CF, Baum SJ, Stroes ESG, Ali S, Khilla N, Hamlin R, Pordy R, Dong Y, Son V, Gaudet D. Evinacumab in Patients with Refractory Hypercholesterolemia. N Engl J Med. 2020 Dec 10;383(24):2307–19. https://doi.org/10.1056/NEJMoa2031049.

6.•

Gray A. Early coronary CT angiography in patients with suspected or provisionally diagnosed acute coronary syndrome: the RAPID CTCA trial. Present Am Heart Assoc Sci Sessions. 2020; In 1,748 patients who presented to the emergency room with chest pain and prior history of coronary heart disease, troponin above the 99^th percentile, or an abnormal electrocardiogram, randomization to early coronary computed tomography angiography did not show reduction in primary outcome of non fatal myocardial infarction at one year compared to usual care.

Yusuf S, Joseph P, Dans A, Gao P, Teo K, Xavier D, et al. Polypill with or without aspirin in persons without cardiovascular disease. United States: N Engl J Med. 2020. https://doi.org/10.1056/NEJMoa2028220.

8.•

Wood FA, Howard JP, Finegold JA, Nowbar AN, Thompson DM, Arnold AD, et al. N-of-1 Trial of a Statin, Placebo, or No Treatment to Assess Side Effects. N Engl J Med. 2020. https://doi.org/10.1056/NEJMc2031173A three arm N-of-1 clinical trial showed that among 60 patients who previously stopped taking statin therapy due to intolerable side-effects, who received statin, placebo and no-pill therapy, 90% of symptoms elicited by statin were also seen in placebo and at 6 months 50% of patients were able to re-start statin therapy.

Jia X, Al Rifai M, Hussain A, Martin S, Agarwala A, Virani SS. Highlights from studies in cardiovascular disease prevention presented at the Digital 2020 European Society of Cardiology Congress: Prevention Is Alive and Well. Curr Atheroscler Rep. 2020;22:72.CrossRef

10.

Jia X, Al Rifai M, Liu J, Agarwala A, Gulati M, Virani SS. Highlights of studies in cardiovascular disease prevention presented at the 2020 American College of Cardiology Annual Scientific Session. Curr Atheroscler Rep. 2020;22:32–6.CrossRef

11.

Al Rifai M, Jia X, Al-Mallah MH, Miedema MD, Martin SS, Virani SS. Major randomized clinical trials in cardiovascular disease prevention presented at the 2019 American College of Cardiology Annual Scientific Session. Curr Atheroscler Rep. 2019;21:31–3.CrossRef

12.

Jia X, Al Rifai M, Gluckman TJ, Birnbaum Y, Virani SS. Highlights from selected cardiovascular disease prevention studies presented at the 2019 European Society of Cardiology Congress. Curr Atheroscler Rep. 2019;21:46–7.CrossRef

13.

Teerlink JR, Felker GM, McMurray JJ, Solomon SD, Adams KF, Cleland JG, et al. Chronic Oral study of myosin activation to increase contractility in heart failure (COSMIC-HF): a phase 2, pharmacokinetic, randomised, placebo-controlled trial. Lancet. 2016;388:2895–903.CrossRef

14.

Packer M, Anker SD, Butler J, Filippatos G, Pocock SJ, Carson P, et al. Cardiovascular and renal outcomes with Empagliflozin in heart failure. N Engl J Med. 2020;383:1413–24.

15.

McMurray JJV, Solomon SD, Inzucchi SE, Køber L, Kosiborod MN, Martinez FA, et al. Dapagliflozin in patients with heart failure and reduced ejection fraction. N Engl J Med. 2019;381:1995–2008.CrossRef

16.

Bhatt DL, Steg PG, Miller M, Brinton EA, Jacobson TA, Ketchum SB, et al. Cardiovascular risk reduction with icosapent ethyl for hypertriglyceridemia. N Engl J Med. 2019;380:11–22.

17.

Jia X, Koh S, Al Rifai M, Blumenthal RS, Virani SS. Spotlight on icosapent ethyl for cardiovascular risk reduction: evidence to date. Vasc Health Risk Manag. 2020;16:1–10.CrossRef

18.

ORIGIN Trial Investigators, Bosch J, Gerstein HC, Dagenais GR, Díaz R, Dyal L, et al. N-3 fatty acids and cardiovascular outcomes in patients with dysglycemia. N Engl J Med. 2012;367(4):309–18.CrossRef

19.

Aung T, Halsey J, Kromhout D, Gerstein HC, Marchioli R, Tavazzi L, et al. Associations of Omega-3 fatty acid supplement use with cardiovascular disease risks: meta-analysis of 10 trials involving 77 917 individuals. JAMA Cardiol. 2018;3(3):225–34.

20.

Yokoyama M, Origasa H, Matsuzaki M, Matsuzawa Y, Saito Y, Ishikawa Y, et al. Effects of eicosapentaenoic acid on major coronary events in hypercholesterolaemic patients (JELIS): a randomised open-label, blinded endpoint analysis. Lancet. 2007;369(9567):1090–8.

21.

Hussain A, Ballantyne CM, Saeed A, Virani SS. Triglycerides and ASCVD risk reduction: recent insights and future directions. Curr Atheroscler Rep. 2020;22(7):25–8.CrossRef

22.

Khera AV, Won HH, Peloso GM, Lawson KS, Bartz TM, Deng X, et al. Diagnostic yield and clinical utility of sequencing familial hypercholesterolemia genes in patients with severe hypercholesterolemia. J Am Coll Cardiol. 2016;67:2578–89.

23.

Dewey FE, Gusarova V, Dunbar RL, O’Dushlaine C, Schurmann C, Gottesman O, et al. Genetic and pharmacologic inactivation of ANGPTL3 and cardiovascular disease. N Engl J Med. 2017;377(3):211–21.

24.

Jia X, Liu J, Mehta A, Ballantyne CM, Virani SS. Lipid-lowering biotechnological drugs: from monoclonal antibodies to antisense therapies-a clinical perspective. Cardiovasc Drugs Ther. 2020. https://doi.org/10.1007/s10557-020-07082-x.

25.

Hoffmann U, Truong QA, Schoenfeld DA, Chou ET, Woodard PK, et al. Coronary CT angiography versus standard evaluation in acute chest pain. N Engl J Med. 2012;367(4):299–308.CrossRef

26.

Yusuf S, Bosch J, Dagenais G, Zhu J, Xavier D, Liu L, et al. Cholesterol lowering in intermediate-risk persons without cardiovascular disease. Cholesterol lowering in intermediate-risk persons without cardiovascular disease. N Engl J Med. 2016;374:2021–31.

27.

Roshandel G, Khoshnia M, Poustchi H, Hemming K, Kamangar F, Gharavi A, et al. Effectiveness of polypill for primary and secondary prevention of cardiovascular diseases (PolyIran): a pragmatic, cluster-randomised trial. Lancet. 2019;394:672–83.

28.

Bruckert E, Hayem G, Dejager S, Yau C, Bégaud B. Mild to moderate muscular symptoms with high-dosage statin therapy in hyperlipidemic patients--the PRIMO study. Cardiovasc Drugs Ther. 2005;19:403–14.CrossRef

29.

Cohen JD, Brinton EA, Ito MK, Jacobson TA. Understanding statin use in America and gaps in patient education (USAGE): an internet-based survey of 10,138 current and former statin users. J Clin Lipidol. 2012;6:208–15.CrossRef

30.

Virani SS, Akeroyd JM, Ahmed ST, Krittanawong C, Martin LA, Slagle J, et al. The use of structured data elements to identify ASCVD patients with statin-associated side effects: Insights from the Department of Veterans Affairs. J Clin Lipidol. 2019;3:797–803.e1.CrossRef

31.

Ahmed ST, Akeroyd JM, Mahtta D, Street R, Slagle J, Navar AM, et al. Shared decisions: a qualitative study on clinician and patient perspectives on statin therapy and statin-associated side effects. J Am Heart Assoc. 2020;9:e017915.CrossRef

Titel: Highlights from Studies Presented at the American Heart Association Scientific Session 2020: Navigating New Roads in Prevention
verfasst von: Aliza Hussain
Mahmoud Al Rifai
Dhruv Mahtta
Jing Liu
Vardhmaan Jain
Salim S. Virani
Publikationsdatum: 01.01.2021
Verlag: Springer US
Erschienen in: Current Atherosclerosis Reports / Ausgabe 1/2021
Print ISSN: 1523-3804
Elektronische ISSN: 1534-6242
DOI: https://doi.org/10.1007/s11883-020-00900-5

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Highlights from Studies Presented at the American Heart Association Scientific Session 2020: Navigating New Roads in Prevention

Abstract

Purpose of the Review

Recent Findings

Summary

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