Key Points

– Coronary sinus reduction (CSR) is a potential therapeutic device for patients with refractory angina
– In this first-of-its-kind randomized, placebo-controlled, double-blind trial, participants underwent CSR implantation or a placebo procedure, with pre- and post-trial CMR and daily angina reporting
-Participants who received a CSR reported fewer episodes of angina, but CMR did not demonstrate improved blood flow

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Key Points:

• Achieving hypertension control has remained an elusive goal in the US and globally, and procedural treatments like renal denervation have gained traction as a means to successfully overcome non-adherence to traditional lifestyle and medical treatment for hypertension. 
• The TARGET BP I investigated a novel percutaneous device, capable of injecting a small amount of alcohol into the renal artery perivascular space, to achieve a circumferential and confluent (yet self-limited) arc of ablation of the sympathetic nervous system. 
• Between 2019 and 2023, 301 patients with hypertension despite treatment with 2-5 medications were randomized 1:1 to renal denervation or sham control. At 3 months of follow-up, there was a modest but statistically significant reduction in 24-hour ambulatory systolic blood pressure (-10.0 ± 14.2 mm Hg versus -6.8 ± 12.1 mm Hg, i.e. a delta of -3.2 mm Hg with 95%CI -6.3 to 0.0, P=0.049), but no reduction in office systolic blood pressure, nor office or ambulatory diastolic blood pressure. This was in the context of an alarmingly high rate of medication non-adherence in both arms (50-60%).
• While encouraging, these results require confirmation via longer follow-up beyond 3 months, in order to understand whether alcohol-mediated renal denervation will demonstrate persistent reduction in blood pressure and perhaps show a larger advantage of the sham control arm, which may be expected to further worsen in hypertension control over time. 

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Key Points:

• GDMT utilization is suboptimal among American Indian patients with HFrEF in Navajo Nation.
• In this pragmatic, stepped-wedge, randomized clinical trial, a telehealth intervention using telephone calls and remote BP monitoring was significantly more effective than usual care in rapid GDMT optimization.  

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Key Points:

• Little is known about the prevalence of cardiovascular risk factors or disease in former professional athletes.  Gaps may exist between the awareness and prevalence of CVD in this population. 
• This cross-sectional study of National Football League (NFL) alumni who participated in cardiovascular screening events found that 90% had HTN, 46% had an abnormal EKG, and 62% had structural abnormalities on TTE.  Overall, 84% were found to have an elevated BP but only 38% had a self-reported a history of HTN. 
• There may be a significant knowledge gap between self-awareness of CVD and actual CVD prevalence among retired NFL athletes.

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Key Points:

• Research coordinators embedded in community-based practices can help ensure that underrepresented and underserved patients have equitable point-of-care access to decentralized clinical trials.
• This study evaluated a need-based protocol-specific workshop to train medical assistants at Health360x practices in research coordination, and compared them to enrollees in a formal didactic Clinical Research Coordinator Certificate program.
• Medical assistants enrolled in the Health360x needs-based, protocol-specific training program were more likely to complete the training and remain engaged in research activities.  
• This flexible training approach can be used to build sustainable, equitable research infrastructure in community-based practices over time.

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Key Points:

• Low-SES patients are less likely to attend CR following hospitalization for a major cardiovascular event and are more likely to be readmitted compared to those with higher SES.
• The HeLP study found that low-SES adults who were randomized to weekly calls from a case manager, financial incentives, or both had higher rates of post-discharge CR attendance compared to usual care.

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Key Points:

• The MINT trial found that among patients with acute MI and anemia, those randomized to a liberal transfusion strategy had lower rates death or MI at 30 days compared to a restrictive strategy; this result approached but did not reach statistical significance. 
• This prespecified subgroup analysis found that the restrictive strategy resulted in a higher rate of death or MI in patients with Type 1 but not Type 2 MI, however the p-value for interaction was not significant.
• Further research is needed, as this analysis was likely underpowered to detect a clinically significant differential response to transfusion strategy based on MI type. 

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Key Points:

• The latest AHA/ACC Heart Failure (HF) guidelines recommend routine assessment of patient-reported health status, but no randomized trials have analyzed its possible impact on routine HF care.
• This study compared routine health status assessment with the Kansas City Cardiomyopathy Questionnaire-12 (KCCQ-12) with usual care among HF clinic patients.
• Primary outcome was patient-reported health status at 1 year while secondary outcomes included therapy patterns, testing, and care utilization. 
• The study did not show significant differences in patient-reported health status between the KCCQ-12 arm and the usual care arm, nor differences in therapy patterns, testing, and care utilization.

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Key Points:

• HTN is a leading cause of cardiovascular (CV) morbidity and mortality worldwide, but blood pressures remain uncontrolled worldwide.
• Spirituality, a comprehensive concept encompassing both personal and interpersonal factors, has been previously studied as a protective factor against CV disease.
• The authors conducted a randomized non-inferiority trial comparing intervention with a daily WhatsApp message, encouraging forgiveness, gratitude, optimism or life purpose, versus usual care for 12 weeks on peripheral and central BP.
• The intervention group demonstrated a significant improvement in both peripheral (7.6 mmHg; p<0.001) and central BP compared to the control group, suggesting evidence of BP improvement with a spirituality intervention on par with many anti-hypertensive medications.

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Key Points: 

• The burden of coronary artery disease (CAD) is high in South Asia, but challenges are present with time-sensitive cardiac care, as evidenced within Karachi, Pakistan (population: >23 million)  
• This study deployed portable chest pain units (CPUs) across Karachi to enhance access to primary percutaneous coronary intervention (PCI) to evaluate CPUs’ effect on primary PCI access 
• CPUs (complete with cardiologist, crash cart, and prompt evaluation and ECG) coincided with substantial annual increase (16-20%) in primary PCI volume with significantly reduced ischemic time 
• Results from this positive study of standalone CPUs may have ramifications for acute MI care in densely populated LMICs, given CPUs’ demonstrable scalability and cost-effectiveness 

South Asia has the highest burden of CAD globally with high rates of acute MI (AMI), even occurring in individuals younger than 40 years old. Within South Asia, Pakistan has the highest rate of ischemic heart disease (IHD) mortality and disability adjusted life-years (DALYs). One significant factor contributing to this epidemic is limitations on timely access to primary PCI. Notably, the Government of Sindh approved a program in 2016 offering free primary PCI, doubling the rate of primary PCI from 1500 per year prior to more than 4000 cases in 2016. Access to primary PCI is very challenging in this setting given major traffic issues and emergency room overcrowding. In Karachi, Pakistan, a city of over 23 million, efforts were made to establish stand-alone portable chest pain units (CPUs) across the city in order to expedite evaluation and referral of AMI patients to the local National Institute of Cardiovascular Diseases (NICVD), currently the world’s largest primary PCI center.  

Multiple CPUs were strategically deployed throughout Karachi based on population density. From 2017 to 2023, 915,564 patients were evaluated for chest pain. 33.5% (306,794) were found to have a primary cardiac etiology (vs non-cardiac), 24% (223,120) were referred for primary PCI, and 2% of all evaluated (19,580) were found to have a STEMI. Among the STEMI patients, 81% were male, median age was 56 years old (IQR 50-65), and cardiogenic shock (Killip class III or IV) was observed in 1108 patients (5.66% of the STEMI cohort). 

Regarding ischemic time outcomes, median first medical contact to device time was 100 minutes (IQR 80-135), median door to balloon time was 84 minutes (IQR 60-125) for patients presenting directly to NICVD ED, and median total ischemic time (TIT) was 232 minutes (IQR 172-315). The presence of CPUs (3 PCUs in 2017 to 18 PCUs in 2023) coincided with the increased caseload of primary PCI with an annual growth rate ranging from 16% to 20% and total primary PCI volume over 9000 by 2023.  

The authors present a novel model of acute chest pain and MI care in a densely populated LMIC. These units were strategically available in areas where road access was difficult, removing barriers to swift diagnosis and triage. Given the substantial area covered and large population served, these results demonstrate scalability and may be instructive for other densely populated LMICs where acute cardiac care is challenging. Furthermore, the geographical distribution of CPUs ensures each region is within 120 minutes of a primary PCI facility, thereby promoting equitable healthcare access. With such an approach serving as a possible model of cardiac care within resource constraints, the authors conclude that such an approach requires collaboration between public bodies, healthcare professionals, and the local community in order to improve global healthcare systems. 

Key Points: 

• Despite demonstrated effectiveness of many SGLT2-inhibitors and GLP-1 agonists at improving both cardiovascular (CV) and kidney outcomes, utilization of these therapies remains low. 
• Study investigators performed a randomized remote implementation study among 200 patients at high CV or kidney risk who were eligible for but not prescribed SGLT2-inhibitors or GLP-1 agonists.  
• Patients were randomized to either simultaneous education and medication titration or an “education-first” approach with 2 months of education followed by medication titration with primary outcome of guideline-directed medical therapy (GDMT) prescription in 6 months 
• A higher proportion of patients in the simultaneous arm versus the education-first arm (70% vs 56%; p<0.001) demonstrated primary outcome at 6 months, suggesting a remote-team based approach with simultaneous education and prescription can improve T2DM GDMT in high CV or kidney risk groups. 

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Key Points

-Beta blocker therapy in patients with acute MI is the current standard of care, but we lack clinical trials testing this concept in the era of PCI and potent anti-platelet agents

-Participants with acute MI and a preserved LVEF were randomized in an open-label trial to receive either no beta blocker or metoprolol succinate or bisoprolol 

– The primary composite outcome of all-cause death or MI was not significantly different between the group on beta blocker therapy and the group not on beta blocker therapy

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Key Points:

• EDTA is a highly effective chelator of the ubiquitous pollutants lead and cadmium, both of which are associated with elevated cardiovascular risk. 
• The first TACT study found that the subgroup of patients with prior MI and diabetes randomized to EDTA had markedly lower cardiovascular event rates compared to placebo.
• The current TACT2 study sought to replicate those results, and randomized 1000 post-MI diabetic patients to EDTA, high-dose oral multivitamins, or corresponding placebos.
• Contrary to the signal seen in the first TACT study, TACT2 found no significant differences in the primary composite cardiovascular endpoint between the EDTA and placebo arms.

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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.

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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 

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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. 

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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.

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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.

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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.

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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. 

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