Key Points:

• The optimal time to de-escalate from DAPT to SAPT following PCI with modern DES after ACS is uncertain.
• The ULTIMATE-DAPT study found that transitioning from aspirin and ticagrelor to ticagrelor alone after 1 month was superior for bleeding outcomes and non-inferior for ischemic outcomes at 12 months compared to continuous DAPT for 12 months.

Continue reading →

Key Points 

– Newer cholesterol guidelines advise lower target values for LDL-C for high-risk patients, yet many patients do not reach this goal on statin therapy alone
– Lerodalcibep is a small binding protein that blocks binding of PCS9 inhibitor to the LDL-R, promoting increased uptake of LDL-C
– LIBerate-HR trial assessed the efficacy and safety of lerodalcibep in patients at very-high and high risk for CVD compared to placebo
– Lerodalcibep, injected once monthly, was found to significantly lower LDL-C as well as ApoB and Lp(a), compared to placebo 

  Continue reading →

Key Points:

• Olezarsen is an antisense oligonucleotide which targets messenger RNA for apolipoprotein C-III (APOC3), a lipoprotein which up-regulates triglyceride levels. 
• BRIDGE-TIMI 73a was a phase 2b randomized, placebo-controlled trial designed to study the efficacy and safety of olezarsen. A total of 154 individuals with moderately elevated triglycerides and cardiovascular risk factors or severely elevated triglycerides were enrolled and randomized to monthly olezarsen or placebo. 
• At a 6 month follow up, olezarsen significantly reduced triglyceride levels as compared to placebo. 

Continue reading →

Key Points:

• Hypertension (HTN) guidelines recommend treating obstructive sleep apnea (OSA) in such patients, though data on BP reduction for mandibular advancement devices (MADs) and continuous positive airway pressure (CPAP) is limited.
• This randomized non-inferiority trial investigated effectiveness in primary outcome of 24-hour mean BP reduction between MAD therapy versus standard CPAP therapy.
• Mean BP difference between MADs and CPAP demonstrated non-inferiority of MAD therapy, and MAD therapy further demonstrated larger BP reduction and higher percentage of study participants with SBP < 120 mmHg.
• These results suggest MAD may be an effective alternate therapy to CPAP for those with moderate-to-severe OSA and HTN.

Continue reading →

Key Points:

• There is uncertainty determining who is likely to develop dysglycemia and type 2 diabetes mellitus (T2DM) due to weight gain and adiposity: 80% of those with obesity do not develop T2DM, and 50% of persons with T2DM do not have obesity.
• Targeting weight loss to certain individuals could personalize the prevention of T2DM, helping determine who is most likely to benefit from weight loss therapy to prevent T2DM.
• A total of 445,765 participants in the UK Biobank were analyzed, of whom 28,563 developed T2DM, in order to infer if more T2DM cases are inherited or acquired, to determine if there is optimal timing of T2DM prevention, and to ascertain if certain groups are more likely to benefit from T2DM prevention.
• Given substantial variation in the effect of BMI on A1c depending on multiple variables, individuals may have a “personal weight threshold” for developing T2DM that could be individually targeted.

Continue reading →

Key Points:

• Post-MI adverse cardiovascular events remain high despite robust evidence-based antiplatelet, statin, and anticoagulant therapy.
• Cholesterol efflux is impaired post-MI and has been associated with  short- and long-term MACE. A novel human plasma–derived apolipoprotein A1 (CSL112) was developed to increase cholesterol efflux capacity with the goal of improving cholesterol efflux post-MI.
• In the AEGIS-II study, intravenous infusions of CSL112 were compared with placebo in patients with type I acute MI. The primary endpoint was 90-day CV death, MI, or stroke.
• CSL112 did not result in a significant reduction in the primary endpoint; however, patients treated with CSL112 infusions had numerically lower rates of CV death and MI, type-1 MI, and stent thrombosis-related MI compared to placebo. 
• In an exploratory analysis, CSL112 significantly reduced the primary endpoint in a subgroup of individuals with LDL ≥100 mg/dL.

Continue reading →

Key Points:  

• The SMART trial is the first randomized non-inferiority trial to test a head-to-head comparison between the Medtronic Evolut valve (Evolut PRO/PRO+/FX) and Edwards SAPIEN valve (SAPIEN 3/3 Ultra) in patients with severe aortic stenosis and small aortic annuli. 
• In the SMART trial, there was no significant difference in the primary composite outcome of mortality, disabling stroke or heart failure hospitalization at 12 months between patients who received the Evolut valve and those who received the SAPIEN valve. 
• Patients who received the Evolut valve had a lower incidence of bioprosthetic valve dysfunction and improved hemodynamics including a larger effective orifice area and lower mean gradient compared to those who received the SAPIEN. 

Continue reading →

Key Points: 

• • Zilebesiran is a subcutaneous injectable that targets hepatic angiotensinogen (AGT) synthesis by RNA interference.
  • The KARDIA-1 trial showed that subcutaneous zilebesiran is associated with sustained reduction in systolic blood pressure. 
  • In KARDIA-2, patients with mild to moderate uncontrolled hypertension were randomized to receive one subcutaneous injection of zilebesiran 600 mg versus placebo in addition to one standard-of-care anti-hypertensive therapy.
  • The investigators found a statistically significant reduction in average ambulatory systolic blood pressure with the addition of zilebesiran at 3 months and 6 months compared to placebo.
  • The most commonly seen adverse events with the use of zilebesiran were hypotension, hyperkalemia and decrease in renal function, all of which were typically transient issues.

Continue reading →

Key Points:

• The majority of US adults at elevated risk for ASCVD do not engage in the recommended amount of daily exercise.
• Behavioral economic strategies to incentivize increased physical activity have shown promise in short-term trials.
• The purpose of this randomized controlled trial was to determine the impact of these strategies when applied in combination and followed over a longer period of time.
• Adults at elevated ASCVD risk who were randomized to a 12 month intervention of gamification, financial incentive, or a combination of the two significantly increased their physical activity from baseline compared to a control arm consisting solely of text message alerts, however only the combination arm outperformed the control arm 6 months after the intervention period ended.

Continue reading →

Key Points:

• Semaglutide, a glucagon-like peptide-1 (GLP-1) analogue, has previously been shown to reduce body weight and improve HF-related symptoms among individuals with HFpEF and obesity who did not have diabetes. Whether similar benefit occurs among individuals with type 2 diabetes mellitus has been unknown.  
• The STEP-HFpEF DM trial enrolled 616 patients with obesity-related HFpEF and type 2 diabetes mellitus and randomized them to once weekly subcutaneous semaglutide or placebo.
• At 1-year follow-up, treatment with semaglutide resulted in a greater improvement in HF-related symptoms as assessed by the KCCQ clinical summary score and greater weight loss as compared to placebo. 

Continue reading →

Key Points:  

• TELE-ACS evaluates the use of telemedicine strategies to reduce hospital readmission rates in patients with a recent history of acute coronary syndrome 
• There was a 76% reduction in hospital readmission in the first six months for patients with a history of ACS who received the telemedicine intervention compared to controls (HR: 0.24, 95% CI: 0.13-0.44, p < 0.00)  
• The use of a telemedicine intervention resulted in a 41% reduction in emergency department visits (HR: 0.59, 95% CI HR: 0.40-0.89, p < 0.001) 

Continue reading →

Key Points:

• Most patients with atherosclerotic cardiovascular disease (ASCVD) do not achieve sufficiently reduced low-density lipoprotein cholesterol (LDL-C) levels despite maximum-tolerated lipid-lowering therapy (LLT) to improve cardiovascular outcomes.
• Twice-yearly inclisiran therapy added to maximum-tolerated statin therapy reduces LDL levels by an additional 50% compared to maximum-tolerated statin therapy alone.
• The investigators randomized 450 participants to either inclisiran 284 mg at day 0, day 90, and day 270 plus usual LLT versus usual LLT alone.

• The “inclisiran-first” strategy resulted in greater reductions in LDL and more patients reaching goal LDL reduction with minimal and comparable adverse effects.

Continue reading →

Key Points:

• Incident heart failure remains common among patients who experience acute myocardial infarction despite recent advances in medical therapy and revascularization strategies. 
• The EMPACT MI trial randomized 6,522 participants with acute myocardial infarction (STEMI or NSTEMI) at high risk of heart failure to empagliflozin 10mg daily or placebo.
• Over a median follow-up of 17.9 months, the primary endpoint of time to first heart failure hospitalization or all-cause mortality was not significantly reduced with empagliflozin. 

Continue reading →

Key Points:

• Up to 1 in 10 women experience a hypertensive disorder of pregnancy, which is associated with long-term cardiovascular disease. However there are no established interventions to reduce risk post-partum.
• The POP-HT study examined the impact of a targeted physician-optimized postnatal BP control regimen on long-term BP control and cardiac remodeling.
• Physician-Optimized post-partum BP control resulted in a significant reduction in both systolic and diastolic BP at 9 months, in addition to BP-related postnatal admissions and evidence of adverse cardiac remodeling on both cardiac MRI and echocardiogram.

Continue reading →

Key Points:

• Uncontrolled hypertension is a major public health concern, and this condition is often primarily driven by the renin-angiotensin (RAAS) pathway.
• A new RNA interference therapy, Zilebesiran, was developed to target to most upstream precursor of the RAAS pathway (angiotensinogen). This study was a Phase 2 study examining the safety and efficacy of zilebesiran.
• A single dose of subcutaneous zilebesiran resulted in sustained BP reduction with low rates of adverse events over 6 months.

Continue reading →

Key Points:

• Despite the advent of PCSK9 inhibitors, the majority of patients with familial hypercholesterolemia do not meet their LDL-C targets with standard therapies. 
• VERVE-1 is a novel CRISPR base editing medication which was designed to inactivate hepatic PCKS9 with a single DNA base pair change, thus reducing LDL-C.
• In this study, the highest dose of VERVE-101 treatment resulted in a sustained >55% LDL-C reduction at 180 days. VERVE-101 was generally well tolerated, with mild infusion reactions at high doses and two observed severe adverse CV events which were attributed to underlying severe ASCVD.

Continue reading →

Key Points:

• The global burden of hypertension is high and increasing, with high rates of underdiagnosis and undertreatment.
• This study implemented a multi-pronged implementation package of HTN treatment within the capital of Nigeria.
• Results showed significant improvement in BP control and successful uptake of the implementation package, specifically anti-HTN medication prescription.
• The investigators hope to scale up this intervention to all the major geopolitical regions within Nigeria.

Continue reading →

Key Points

• This cluster-randomized trial found that a multifaceted implementation strategy to target an SBP <120 among low-income patients cared for at FQHCs lead to a significant reduction in mean blood pressure and a significant increase in the proportion of patients who achieved an SBP <120 compared to usual care.
• This strategy could be applied widely to other practices caring for low-income patients experiencing health disparities.

Continue reading →

Key Points

• Novel speech processing technology has the potential to detect heart failure exacerbations before they happen, and may be better than the conventional weight monitoring approach.
• Additional studies are needed to explore the generalizability, practicality, efficacy, and effectiveness of the HearO model.

Continue reading →

Key Points

• In two simultaneous pragmatic trials, an asynchronous, non-visit based, automated order for statins placed to a centralized pharmacy significantly increased both overall statin and appropriate dose statin prescriptions, while an interruptive visit based EHR notification strategy had an overall smaller effect.

Continue reading →