Despite the ongoing COVID-19 pandemic, researchers made important gains in 2022 in the fight against cardiovascular disease (CVD), according to the American Heart Association’s (AHA) annual overview of pivotal scientific developments in the field.
“Scientific research is key to lowering the global burden of heart disease and stroke. This past year brought us some very rich scientific findings that I think will make a real impact,” Mariell Jessup, MD, AHA chief science and medical officer, said in a news release.
Here is a brief summary of some of the year’s most noteworthy developments, according to the AHA.
Greater Understanding of How CVD Starts in Childhood
For the first time, robust data provided a direct link between childhood risk factors and cardiovascular events later in life.
The International Childhood Cardiovascular Cohort (i3C) Consortium reported that several traditional CVD risk factors present in children and adolescents were associated with CV events three or more decades later. The study focused on body mass index (BMI), systolic blood pressure, smoking, and total cholesterol and triglyceride levels.
The i3C researchers found clear associations between a high level of each childhood risk factor and the occurrence of CVD later in life, beginning as early as age 40. For each unit higher in the combined childhood risk factor score, the risk for having a CV event in adulthood nearly tripled.
Individuals with the highest level of childhood risk factors had the highest risk of later CV events. However, even slightly elevated risk scores that would be considered average for children were associated with a higher risk for CV events, compared with those who had the lowest risk factor levels in childhood.
The study was published in May in the New England Journal of Medicine.
Strong Support for Treating Mild Hypertension in Pregnancy
The benefits and safety of antihypertensive therapy for mild chronic hypertension (BP <160/100 mm Hg) during pregnancy have been uncertain.
The Chronic Hypertension and Pregnancy (CHAP) study showed that pregnant women with even mild hypertension should receive blood pressure–lowering medications to reduce the likelihood of adverse outcomes for the mother and child.
The study of roughly 2400 pregnant women showed that treating to a target BP of <140/90 mm Hg was associated with better pregnancy outcomes vs no treatment, with no increase in the risk of small-for-gestational-age birth weight.
The study, published in the New England Journal of Medicine and reported by theheart.org | Medscape Cardiology, is already leading to changes in practice and clinical practice guidelines.
Clues to Maternal Heart Health Found in the Placenta
For women with poor pregnancy outcomes, clues to their long-term cardiovascular health might be present in the placenta, according to a study published in Hypertension.
A decade after delivery, researchers found that women with placental vascular lesions had a poor CV profile comprising microvascular rarefaction, higher blood pressure, and more atherogenic lipids.
The results suggest that placental histopathology may reveal a woman’s early trajectory toward subsequent vascular disease.
Progress Understanding Racial Disparities in Early CVD
Using more than 30 years of data for roughly 5000 participants in the Coronary Artery Risk Development in Young Adults (CARDIA) study, researchers quantified the contribution of socioeconomic, neighborhood, clinical and lifestyle factors to CVD disparities.
They found a higher risk for premature CVD in Black vs White men and women. The most significant contributors to racial differences were from clinical and neighborhood factors in women, and clinical and socioeconomic factors in men.
Addressing how these factors contribute to disparities at public health and individual levels may help guide strategies to reduce health disparities and improve healthcare for affected people, the study team said in Circulation.
Polypills for Secondary CVD Prevention
The Secondary Prevention of Cardiovascular Disease in the Elderly (SECURE) trial showed that treatment with a polypill containing aspirin, ramipril, and atorvastatin within 6 months after myocardial infarction resulted in a significantly lower risk of major adverse CV events than usual care.
As hoped, those who took the polypill had better treatment adherence, leading to a 27% lower risk for CV events, the study team reported in the New England Journal of Medicine.
Expanding the Patient Pool for SGLT2 Inhibitors
Several studies indicating that sodium-glucose cotransporter 2 (SGLT2) inhibitor therapy, originally developed for diabetes, is helpful in a broader patient population made AHA’s list of major developments in 2022.
Results of the DELIVER study provided strong support for SGLT2 inhibitor therapy in patients with heart failure regardless of their left ventricular function.
In the study, treatment with dapagliflozin (Farxiga) reduced the combined risk of worsening heart failure or CV death over a median of 2.3 years in heart failure patients with only mildly reduced or preserved ejection fraction. SGLT2 inhibitors have already been shown to benefit patients with severe heart failure.
The study was published in the New England Journal of Medicine and presented at the European Society of Cardiology (ESC) annual congress, with coverage by theheart.org | Medscape Cardiology.
A meta-analysis of five randomized controlled trials published in the Lancet provided further evidence that SGLT2 inhibitors could benefit a wider range of heart failure patients.
“SGLT2 inhibitors are the bedrock of therapy for heart failure regardless of ejection fraction or care setting,” wrote the co-authors of a Lancet Comment.
And the EMPA-KIDNEY study showed that the SGLT2 inhibitor, empagliflozin (Jardiance), is effective in a wider range of patients with chronic kidney disease than previously studied, including people without diabetes and those with less severe kidney disease.
Across the board, patients who took empagliflozin were less likely to experience worsening kidney disease or death from CV causes over 2 years of follow-up, the authors found.
Results from the EMPA-KIDNEY trial were presented during Kidney Week 2022, simultaneously published in the New England Journal of Medicine, and reported by theheart.org | Medscape Cardiology.
Two Drugs Better Than One in Marfan Syndrome
Marfan syndrome is an inherited connective tissue disorder that can affect many parts of the body, especially the cardiovascular system.
An analysis of individual patient data from 1442 patients with Marfan syndrome found that angiotensin receptor blockers (ARBs) and beta-blockers are similarly effective and that using them in combination is more effective in slowing aortic enlargement than using either drug alone.
Advances in Preventing Disability After Stroke
A phase 3 trial published in the Lancet provided evidence that next-generation thrombolytic, tenecteplase, is as effective as alteplase, the current standard of care.
In a head-to-head comparison, both medications were similarly safe and effective at preventing further disability 90 days after a stroke.
“The results clearly showed noninferiority of tenecteplase to alteplase for functional outcomes at 90 days, with a trend toward superiority, and safety was similar for the two drugs,” Rick Swartz, MD, Sunnybrook Health Sciences Centre, Toronto, Canada, said in reporting the ACT trial results at the European Stroke Organisation Conference (ESOC).
Meanwhile, in the CHOICE trial, giving intra-arterial alteplase after successful thrombectomy in patients with acute ischemic stroke led to a large increase in the number of patients achieving an excellent neurologic outcome at 90 days.
The study was published in JAMA to coincide with presentation at the International Stroke Conference (ISC) 2022, where it received a round of applause, as reported by theheart.org | Medscape Cardiology.
The AHA also cites the RESCUE-JAPAN LIMIT trial, which showed that patients with large cerebral infarctions had better functional outcomes with endovascular therapy than with medical care alone.
New Data on Salt and CVD
A study in China found that reducing sodium intake by using a lower-sodium table salt substitute, containing 25% potassium chloride, lowered stroke risk and reduced healthcare costs. The authors said this strategy should be a priority in any country in which dietary sodium can be substantially reduced by use of a salt substitute.
The Salt Substitute and Stroke Study (SSaSS) was published in Circulation.
Obesity Drug on Par With Surgery?
In the SURMOUNT-1 trial, a once-weekly injection of tirzepatide (Mounjaro), a novel glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1 receptor agonist, led to significant weight loss on par with that achieved via bariatric surgery in people with obesity.
The results were presented in June at the American Diabetes Association (ADA) 82nd Scientific Sessions and simultaneously published in the New England Journal of Medicine.
A complete review of the AHA’s top picks for leading cardiovascular-related research accomplishments published in 2022 is available online.
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