2. ACC24
April 6 - 8, 2024 Atlanta
In the management of Hypertension, Angina, CAD, Post MI, AF, HF In ACS, High Risk CAD & Post PCI
Scientific Initiative by
CSL 112 (Apolipoprotein A-I) Infusions and Cardiovascular Outcomes in Patients with Acute
Myocardial Infarction (ApoA-I Event Reducing in Ischemic Syndromes II (AEGIS-II) Trial)
Gibson C.
This study shows enhancing HDL function by using infusing human ApoA-1 would enhance effects and decrease the
chance of recurrent cardiovascular (CV) occasions after AMI. An international, multicenter, randomized,
double-blind, placebo-controlled trial conducted involving involving 18,231 AMI patients aimed to increase HDL
function and reduce the risk of recurrent cardiovascular events following AMI. Patients were randomized to receive
ApoA-I (6g CSL112) infusions or a placebo. The primary objective was to determine the time to first prevalence of CV
death, MI, or stroke in 90 days. Secondary efficacy outcomes included hospitalizations for coronary, cerebral, or
peripheral ischemia from randomization through 90 days and 180 days. With no or fewer observed imbalances in
hypersensitive reaction occasions, acute kidney injuries activities, potential hepatic injury events, or new or
worsening heart failure activities. Conclusion: It found that CSL112 infusions did not show a significant reduction in
cardiovascular death, heart attack, or stroke compared to a placebo over a 90-day period. However, the study noted
consistency in the primary endpoint across predefined subgroups.
Double-blind, Randomized Placebo-Procedure-Controlled Trial of an Interatrial Shunt in
Patients with HFrEF and HFpEF: Principal Results from the RELIEVE-HF Trial
Stone G.
A randomized, double-blind, placebo-procedure-controlled, multicenter trial examined the safety & efficacy of the
V-Wave Ventura IAS device in symptomatic HF patients with any LVEF. Ventura 5.1-mm interatrial shunt
decompresses left atrium, according to research. The Ventura shunt's crucial Investigational Device Exemption (IDE),
the RELIEVE-HF approval trial, comprised heart failure (HF) patients with any LVEF who remained symptomatic after
maximum tolerable class I HF therapies and a 6MWD between 100 & 450 Patients were randomized 1:1 to Ventura
shunt installation or placebo. Patients and healthcare assessors were blinded for the 2-year follow-up or until the
last enrolled patient reached 1 year. The primary objective was a hierarchical ranking of all-cause mortality, heart
transplant or LVAD implantation, recurrent HF hospitalizations, outpatient worsening HF episodes, and KCCQ-OS
score change. The patients' mean LVEF was 45.0%, with 40.4% HFrEF and 59.6% HFpEF. PCWP averaged 16.6 mmHg,
RAP 9.3 mmHg, & PVR 2.3 Wood units. Transcatheter Ventura inter-atrial shunt placement was safe but did not
enhance symptoms or prognosis in HF patients of all LVEF levels after 2 years.
Empagliflozin After Acute Myocardial Infarction: Results of the EMPACT-MI Trial
Butler J.
This study evaluated the safety and efficacy of Empagliflozin in patients who have had acute myocardial infarction.
Despite advances in treating AMI, individuals with congestion or left ventricular dysfunction are at high risk of heart
failure (HF) in the year after an incident. Inhibitors of SGLT2 have consistently reduced HF risk. Empagliflozin was
studied in double-blind, randomized, placebo-controlled trial in 6522 post-MI patients in the EMPACT-MI study.
Eligible patients had no previous HF, were hospitalized for AMI with congestion or decreased LVEF, and had at least
one HF risk factor. Time to first HF hospitalization or all-cause death was the main outcome. Over a median
follow-up of 17.9 months, 8.2% of empagliflozin patients had the main result compared to 9.1% on placebo, albeit
this difference wasn't statistically significant. Empagliflozin reduced HF hospitalizations (3.6% vs. 4.7%) but not
all-cause mortality. Conclusion: After AMI Empagliflozin reduced initial HHF risk by 23% and total HHF risk by 33%,
respectively, in the main and first critical secondary endpoints. HHF risk decrease was consistent across subgroups
and sensitivity analyses.
3. ACC24
April 6 - 8, 2024 Atlanta
In the management of Hypertension, Angina, CAD, Post MI, AF, HF In ACS, High Risk CAD & Post PCI
Scientific Initiative by
Relationship Between Major Bleeding Events and Chronic Kidney Disease in Patients Undergoing
Percutaneous Coronary Intervention
Iyer M. and team
This study is highlighting a lack of detailed description regarding the relationship between chronic kidney disease
(CKD) and the frequency and types of major bleeding events following percutaneous coronary intervention (PCI). A
PCI data analysis tool, the CathPCI Database, was utilized to research CKD patients between 2009 and 2017. The
most prevalent CKD stages were 1-5 based on eGFR. Following NCDR guidelines, serious in-hospital bleeding
incidents were the focus. Out of 13,537 PCI patients, 817 had bleeding episodes, 6.0%. Dialysis and CKD Stages 3a,
3b, 4, and 4 independently predicted severe bleeding after PCI. The degree of baseline CKD is a robust and
independent predictor of heightened risk for major bleeding events post PCI, including the need for blood
transfusion, occurrences of GI/GU bleeding, access site hematoma, and asymptomatic drops in haemoglobin.
Estimated Pulse Wave Velocity Elevation is Associated with Adverse Outcomes in Patients with
Heart Failure with Reduced Ejection Fraction: A Post Hoc Analysis of the HF-Action Trial
Hilton T. and crew
This study shows the correlation between predicted arterial pulse wave velocity (ePWV) and effects in sufferers with
coronary heart failure with decreased ejection fraction (HFrEF). EPWV can be used to evaluate arterial stiffness, that
is a separate risk factors for morbidity and mortality. The research involved a total of 2,120 patients identified with
coronary heart failure with decreased ejection fraction (HFrEF). The consequences revealed that higher ranges of
arterial stiffness, as measured by improved ePWV, were strongly related to accelerated risks of mortality and
hospitalization because of any cause. Patients who had an ePWV (better pulse wave speed) underneath the median
and were in the decrease quartiles had decreased death rates. Elevated ePWV was proven to be related to higher
odds of hospitalization due to heart failure or cardiovascular death. In HFrEF sufferers, better ePWV corresponds
with poorer outcomes. The approach employed to decide a patient's ePWV is simple and non-invasive, making this
discovery sizable.
Impact of Chronic Kidney Disease on the Pharmacodynamic and Pharmacokinetic Profiles of
Clopidogrel in The Setting of Type 2 Diabetes Mellitus and Coronary Artery Disease
Paz LO and team
This study examined clopidogrel metabolism and platelet P2Y signaling in DM and CKD patients. Patients received
600 mg loading and 75 mg maintenance clopidogrel. Pharmacodynamic response was assessed by VASP (PRI), LTA
with ADP 20 μM (MPA%), and VerifyNow (PRU). Pharmacokinetic (PK) testing measured clopidogrel and its main
active metabolite. Ex vivo and in vitro testing showed no change in PRI and PRU between CKD and non-CKD
individuals. In vitro, CKD patients had a greater PRI than non-CKD patients, although MPA% and PRU were not
different. Clopidogrel-treated diabetics with CKD had greater MPA levels than non-CKD individuals. This may be due
to P2Y signaling pathway overexpression rather than medication absorption or metabolism.
4. ACC24
April 6 - 8, 2024 Atlanta
In the management of Hypertension, Angina, CAD, Post MI, AF, HF In ACS, High Risk CAD & Post PCI
Scientific Initiative by
Effects of High-Intensity Interval Training on Cardiorespiratory Fitness and Left Ventricular
Function in Patients Enrolled in Cardiac Rehabilitation After Recent Myocardial Infarction
Kaur A.
This study presented High-intensity interval training (HIIT) is more effective than MICT in cardiac rehabilitation for
chronic heart failure and coronary artery disease patients. There is little clinical evidence of its post-MI efficacy. A
comprehensive review of electronic databases found randomized controlled trials (RCTs) comparing HIIT to control
(MICT or regular physical activity) on cardiorespiratory fitness using CPET and left ventricular systolic and diastolic
performance on echocardiography in cardiac rehabilitation post-MI. Revman 5.4.1 was used to assess the mean
difference in 342-patient research using random-effects analysis. The findings demonstrated that HIIT substantially
enhanced peak oxygen consumption, GLS, and LV diastolic function. Ventilator efficiency (VE/VCO2 slope) did not
increase. Although not statistically significant, the HIIT group had improved LV diastolic function than the control
group. In conclusion, post MI patients, HIIT significantly improves exercise capacity and global longitudinal strain.
Dapagliflozin Reduces the White Coat Effect on Blood Pressure of Patients with Type 2 Diabetes:
A Randomized, Active-Controlled Trial
Cavalcante P.
This studied compared Dapagliflozin and Glibenclamide for their ability to control the white coat effect (WCE) in
high-risk individuals with type 2 diabetes and cardiovascular disease. A phase-4 BHS2 open-label, single-center,
active-controlled trial sub-analysis of the ADDENDA randomized participants to receive Glibenclamide or
Dapagliflozin in addition to Metformin which determined that Dapagliflozin had a more substantial effect than
Glibenclamide on reducing WCE in systolic blood pressure after 12 weeks of treatment. SGLT2i, which regulates
blood glucose, may mitigate WCE in patients by decreasing aberrant vasoconstriction, according to the findings of
the study. This indicates that glycemic control may not be the only mechanism involved in the treatment of WCE.
Dapagliflozin reduced WCE on systolic blood pressure better than Glibenclamide. Orthostatic blood pressure and
morning blood pressure surge did not vary across treatment groups.
The Effects of Olmesartan/Amlodipine Administered in The Morning or At Night on Nocturnal
Blood Pressure Reduction in Chinese Patients with Mild-Moderate Essential Hypertension
(Oman Trial)
Chen X.
This study investigated the effects of morning and bedtime antihypertensive treatment on nocturnal blood
pressure (BP) decrease and the circadian rhythm of hypertensive patients. Randomized, multicenter, open-label
clinical study in China patients aged 18–75 who had not used hypertension medicines for 2 weeks were enrolled
and assigned to or nighttime Patients took one Olmesartan/Amlodipine (OA) tablet (20/5 mg) daily for 4 weeks and
were monitored every 4 weeks for 12 weeks. Groups had similar mean BP differences for ABPM and OBPM at week
4. In group 2, nightly systolic BP (SBP) and diastolic BP (DBP) decreased considerably from baseline at week 12, with
superior nocturnal SBP management and BP load reduction. Bedtime dose controls nocturnal BP better than
morning dosing and improves the circadian rhythm without increasing hypotension risk.
5. ACC24
April 6 - 8, 2024 Atlanta
In the management of Hypertension, Angina, CAD, Post MI, AF, HF In ACS, High Risk CAD & Post PCI
Scientific Initiative by
Dapagliflozin in Patients with Heart Failure across A Range of Left Ventricular
Hypertrophy in the DELIVER Trial
Vaduganathan M., and colleagues
This DELIVER study investigated the relationship between septal wall thickness (SWT) and posterior wall
thickness (PWT) and cardiovascular mortality or worsening heart failure (HF) after dapagliflozin medication.
Of 6,263 patients, 3,988 had SWT and PWT measures, with 93% having a history of hypertension. SWT and
PWT linearly correlated with primary outcome risk. Hypertension did not affect SWT-PWT relationships with
key outcomes. Some individuals without hypertension had increased left ventricular hypertrophy. Despite
varying SWT and PWT ranges, dapagliflozin consistently improved primary outcomes and was
well-tolerated, especially in individuals with severe LVH (≥1.5cm). The findings emphasize the need to know
how SGLT2 inhibitors affect clinical events in HF across LVH spectrums. Dapagliflozin consistently and
safely decreased clinical events in heart failure patients across various degrees of LVH.
Efficacy and Safety of Olezarsen in Patients with Hypertriglyceridemia and High
Cardiovascular Risk: Primary Results of the BRIDGE-TIMI 73a Trial
Bergmark B.
This study assessed the efficacy and safety of Olezarsen in patients with moderate hypertriglyceridemia
and elevated CV risk or with severe hypertriglyceridemia. Adults on stable lipid-lowering therapy with either
moderate hypertriglyceridemia (HTG) (150-<500 mg/dL) plus elevated CV risk or severe HTG (≥500 mg/dL)
were randomized 1:1 to a 50 mg vs 80 mg cohort, and then 3:1 to olezarsen SC Q4W or placebo within each
cohort. Olezarsen 50 mg and 80 mg doses reduced placebo-adjusted TG levels at 6 months by 49% and
53%, respectively (each p<.0001). Both doses also significantly reduced ApoC3 by 64-74%, ApoB by 18%, and
non-HDL-C by 23-25%, with no change in LDL-C. In patients with largely moderate hypertriglyceridemia and
elevated cardiovascular risk, lezarsen led to meaningful reductions in apolipoprotein B and non-high
density lipoprotein cholesterol, markers of atherogenic risk.
Plozasiran (ARO-APOC3), An Investigational RNAi Therapeutic, Demonstrates Profound
and Durable Reductions in APOC-3 and Triglycerides (TG) in Patients with Severe
Hypertriglyceridemia (SHTG), SHASTA-2 Final Results
Gaudet D.
SHASTA-2, was a randomized, placebo-controlled, Phase 2b study trial that evaluated efficacy and safety of
Plozasiran in patients with SHTG. Eligible patients (n=229), randomized 3:1, received a total of 2 doses (SQ
10, 25, or 50 mg plozasiran) or matched placebo on Day 1 and at Wk12 and followed through Wk48.
Plozasiran decreases LS mean serum APOC3, TGs, and remnant cholesterol while increasing HDL-C at 24
weeks (persisting at 48 weeks) for all dose levels: APOC3 lowered to -78%, (-48%); TG lowered to -74%,
(-58%), Remnant cholesterol lowered to -62%, (-45%); HDL-C increased up to +68%, (+38%). Over 90% of
subjects at 24 weeks treated with Plozasiran achieved TGs <500 mg/dL and below the risk threshold for
Acute Pancreatitis. Key atherogenic lipoprotein parameters also improved. The safety profile was favorable
at all doses. These data support the initiation of pivotal studies of Plozasiran for the treatment of SHTG.
6. ACC24
April 6 - 8, 2024 Atlanta
In the management of Hypertension, Angina, CAD, Post MI, AF, HF In ACS, High Risk CAD & Post PCI
Scientific Initiative by
Zilebesiran in Combination with a Standard-of-care Antihypertensive in Patients with
Inadequately Controlled Hypertension – Primary Results from the Phase 2 KARDIA-2 Study
Desai A.
This Phase 2 KARDIA-2 study assessed Zilebesiran in combination with a standard-of-care antihypertensive
medication class in patients with uncontrolled hypertension. Patients with 24-hr mean SBP of 130-160 mmHg
assessed by ambulatory blood pressure monitoring after ≥4 weeks of run-in were randomized 1:1 to a single
dose of SC zilebesiran 600 mg or placebo as add-on therapy. Treatment with a single subcutaneous dose of
Zilebesiran 600 mg was associated with clinically significant reductions in 24-hr mean ambulatory and office
SBP compared with placebo at month 3 when added to a diuretic, CCB, or maximum-dose ARB. These
differences were sustained to month 6 in the Indapamide and Amlodipine cohorts despite add-on
antihypertensive therapy. Zilebesiran has potential to be a novel treatment strategy for patients with
hypertension, both as monotherapy and in combination with current standard of care.
Effect of Gamification, Financial Incentives, or Both Combined to Increase Physical Activity
Among Patients with Elevated Risk for Major Adverse Cardiovascular Events. The Be Active
Randomized Clinical Trial
Fanaroff A.
This study determined the effectiveness of behaviourally-designed gamification, loss-framed financial
incentives, or the combination versus control for increasing physical activity over a 12-month intervention and
6-month follow-up period. In observational studies, there is an inverse association between steps per day and
outcomes (mortality, CV events). These highly scalable, automatically delivered interventions increase physical
activity over long-term periods in patients at high risk for CV events and could improve outcomes. BE ACTIVE,
the largest and longest-duration trial of strategies to increase physical activity, will identify whether strategies
informed by behavioural economic theory promote sustained increases in physical activity in individuals with
or at risk for ASCVD.
Short-Term Dual Antiplatelet Therapy After Drug-Eluting Stenting In patients with Acute
Coronary Syndromes: A Bayesian Network Meta-Analysis of Randomized Controlled
Trials
Nascimento B. R.
The study evaluated the efficacy and safety of short-term antiplatelet therapy in patients undergoing PCI
with DES in the context of ACS, compared to the standard 12-month therapy. This systematic review
yielded 12 RCTs including 28,085 patients. For major bleeding, 3-month DAPT followed by P2Y12i was
superior to conventional 12-month DAPT (RR 0.45; 95% CI 0.20-0.97). In SUCRA analysis, 3-month DAPT
followed by P2Y12i was ranked as the best therapy to prevent both MACE and major bleeding endpoints.
These results were consistent across the subgroups of patients with ST-elevation myocardial infarction and
non-ST elevation ACS. In this network meta-analysis of 12 RCTs, patients with ACS undergoing PCI with DES,
3 months of DAPT followed by P2Y12i monotherapy significantly reduces the risk of major bleeding without
increasing the risk of ischemic events.
7. ACC24
April 6 - 8, 2024 Atlanta
In the management of Hypertension, Angina, CAD, Post MI, AF, HF In ACS, High Risk CAD & Post PCI
Scientific Initiative by
Renal Denervation for Hypertension: A Meta-Analysis of Randomized Controlled Trials
Palicherla A.
The meta-analysis evaluated the magnitude of blood pressure (BP) reduction from renal denervation (RD) in
sham-controlled trials. A total of 11 studies with 1,920 subjects were included in the analysis. Compared to
sham procedure, RD reduced 24 hr ambulatory systolic BP by 3.16 mm Hg (95% CI: -4.96 to -1.37 mm Hg; p
=0.006), ambulatory diastolic BP by 1.75 mm Hg (95% CI: -2.68 to -0.82 mm Hg; p = 0.002), office systolic BP
by 4.60 mm Hg ( 95% CI: -7.75 to -1.45 mm Hg; p=0.004), and office diastolic BP by 3.18 mm Hg (95% CI: -4.51
to -1.85 mm Hg; P <0.01). These findings suggest that RD provides meaningful BP reduction even in
sham-controlled trials, indicating its efficacy beyond a placebo effect or treatment bias. RD could potentially
improve BP control and reduce medication burden in patients with difficult-to-control or resistant
hypertension.
Effectiveness Of Sodium-Glucose Co-Transporter 2 Inhibitors in Patients with Acute
Myocardial Infarction: A Systematic Review and Meta-Analysis
Anwar RU
The study investigated the potential benefits of sodium-glucose co-transporter 2 inhibitors (SGLT2i)
medications for heart attack (acute myocardial infarction or AMI) patients. While these drugs are known to
help heart failure, their role in AMI recovery was unclear. Researchers analyzed data from five studies (over
750 participants) comparing SGLT2i drugs (empagliflozin or dapagliflozin) to placebo in AMI patients. The
analysis found that SGLT2i use led to a statistically significant improvement in LVEF compared to placebo.
However, there were no significant differences between groups in reductions of a heart stress marker
(NT-proBNP) or hospital readmissions for heart failure. Overall, this study suggests that while SGLT2 inhibitors
may improve heart function post-heart attack, their impact on other heart-related outcomes requires further
investigation.
Impact of Alcoholism on Stroke in Patients with Atrial Fibrillation
Dahl A.
The study sheds light on a concerning trend: an elevated stroke risk among atrial fibrillation (AF) patients
with alcoholism. Researchers examined data from nearly 6,000 patients within the Tulane Hospital network,
comparing those with AF and alcoholism (AFAA) to those without alcoholism (AFWA). The AFAA group
displayed significantly higher stroke rates, with 18.1% experiencing strokes compared to 7.9% in the
non-alcoholic group. Despite their heightened risk, fewer AFAA patients received essential anticoagulant
medication. Even after adjusting for various factors, the study concluded that alcoholism independently
increases stroke risk in AF patients, with the AFAA group facing a 31% higher risk. Overall, this study
highlights the necessity for reconsidering treatment strategies to effectively address the heightened stroke
risk associated with alcoholism in AF patients.
18
8. ACC24
April 6 - 8, 2024 Atlanta
In the management of Hypertension, Angina, CAD, Post MI, AF, HF In ACS, High Risk CAD & Post PCI
Scientific Initiative by
Abdominal obesity and outcomes in heart failure with preserved ejection fraction: the
PARAGON-HF Trial
Peikert A.
The study examined the impact of obesity, which affects a significant number of patients with heart
failure with preserved ejection fraction (HFpEF). In the PARAGON-HF trial, 4,796 patients with heart
failure (HF) and left ventricular ejection fraction (LVEF) ≥45% were randomly assigned to receive either
valsartan or sacubitril/valsartan. The study found that both higher BMI and WHtR were associated with
an increased risk of the primary outcome in the multivariable-adjusted model. In the PARAGON-HF study,
increased abdominal adiposity, as evaluated by waist-to-height ratio (WHtR), was linked to an elevated
risk of heart failure hospitalizations and cardiovascular death, without any indication of an
obesity-survival paradox.
Characteristics And Cardiovascular Outcomes of Female Patients Presenting with
ST-Elevation Myocardial Infarction Without Standard Modifiable Cardiovascular Risk
Factors
Shamaki GR
The study examined the in-hospital outcomes of female STEMI patients without standard modifiable
cardiovascular risk factors (SMuRFs) such as hypertension, diabetes mellitus, hyperlipidemia, and
smoking. Primary outcome measures included in-hospital mortality, with secondary outcomes focusing
on STEMI-related complications. Among the 25,445 patients studied, 20,054 (79%) had at least one
SMuRF, while 5,391 (21%) were SMuRF-less. SMuRF-less patients had more congestive heart failure (37.3%
vs. 33.1%, p<0.01) but less COPD (11.9% vs. 19.9%, p<0.01). They also had higher in-hospital mortality (OR
2.3, CI 2.1- 2.6, p<0.01). Female patients without standard modifiable cardiovascular risk factors
(SMuRF-less) who present with ST-segment elevation myocardial infarction (STEMI) experience poorer
in-hospital outcomes compared to patients with one or more SMuRFs.
Preventing Cardiac Damage in Patients Treated for Breast Cancer and Lymphoma: A
Phase 3 Randomized, Open Label, Blinded Endpoint, Superiority Trial of Enalapril to
Prevent Anthracycline-induced Cardiotoxicity (PROACT)
Austin D.
A prospective, multi-center, randomized, blinded end-point, superiority trial of 111 patients at 13 UK
sites. Adults with Breast cancer or Non-Hodgkin lymphoma planned to receive 6 cycles of anthracycline
chemotherapy, with a negative baseline troponin T, consented. Patients were randomized to no Enalapril
or Enalapril titrated to 10mg BD. 81% of patients had myocardial injury on cardiac troponin T criteria.
46% of patients had myocardial injury on cardiac troponin I criteria. 21% had a >15% relative decrease
in LV GLS (Left Ventricular Global Longitudinal Strain). 2% had a >10% reduction in LV EF (left ventricular
ejection fraction) to <50. Adding Enalapril to standard care was not superior to standard care alone in
the prevention of cardiotoxicity in patients receiving high-dose anthracycline-based chemotherapy.
9. ACC24
April 6 - 8, 2024 Atlanta
In the management of Hypertension, Angina, CAD, Post MI, AF, HF In ACS, High Risk CAD & Post PCI
Scientific Initiative by
Topical Tranexamic Acid to Reduce Seizures in Cardiac Surgery
Lamy A.
The DEPOSITION trial was a multicenter double dummy, blinded, randomized controlled trial. Each
patient received 2 syringes (up to 10g) for intravenous use and 2 syringes (up to 10g) for topical use. The
sample size was 3800 patients. The primary outcome was seizures (hypothesis: superiority of topical
TxA). The secondary outcome was red blood cell transfusions (hypothesis: non-inferiority of topical TxA).
The 3,224 patients from 16 centres in 6 countries were recruited, with 1,615 allocated to topical TxA and
1,609 allocated to intravenous TxA, which were included in the intent-to-treat analyses.. The 10-day
follow-up was complete for >98% of patients. Topical TXA does not reduce risk of seizure and increases
the risk of transfusion.
Efficacy and Safety of Ninerafaxstat, A Novel Cardiac Mitotrope, In Patients with
Symptomatic Nonobstructive Hypertrophic Cardiomyopathy: Results of
IMPROVE-HCM
Maron M.
This study evaluated Ninerafaxstat in patients with nonobstructive hypertrophic cardiomyopathy
(nHCM). Patients were randomized to Ninerafaxstat or placebo (1:1) for 12 weeks. After 12 weeks, there
was an increase in ventilatory efficiency in the Ninerafaxstat group compared to placebo with VE/VCO2
-2.32 [-4.35, -0.29]; p=0.026. This change was associated with improved symptoms with an increase in
KCCQ-CSS score of 9.12 (0.96, 17.28) p=0.03 in those patients with a baseline KCCQ-CSS <80.
Ninerafaxstat was safe and well tolerated in nonobstructive HCM. Treatment with Ninerafaxstat was
associated with significant improvement in functional capacity measured by VE/VCO2, an important and
prognostic submaximal cardiopulmonary exercise testing (CPET) variable in HCM.
A Selective Aldose Reductase Inhibitor (at-001) for the Treatment of Diabetic
Cardiomyopathy: Primary Results of the Phase 3 Randomized Controlled ARISE-HF
Study
Januzzi J.
The Aldose Reductase Inhibition for Stabilization of Exercise Capacity in Heart Failure (ARISE-HF) Trial
examined the effects of the highly selective and potent aldose reductase inhibitor AT-001 among
participants with early asymptomatic diabetic cardiomyopathy (DbCM). The study participants were
randomized in a 1:1:1 fashion to receive twice-daily AT-001 (1,000 mg or 1,500 mg) or placebo. 691
participants were enrolled. The average peak V02 was 15.7 ± 3.8 mL/Kg/minute, indicating reduced
physical activity, also indicated by a PASE score of 155. Treatment with AT-001 was safe and
well-tolerated but did not result in a statistically significant difference in peak VO2 among persons with
DbCM and reduced exercise capacity. The study participants in ARISE-HF had very well-controlled
T2DM (A1c=6.98%), which may not reflect persons with DbCM more generally.
10. ACC24
April 6 - 8, 2024 Atlanta
In the management of Hypertension, Angina, CAD, Post MI, AF, HF In ACS, High Risk CAD & Post PCI
Scientific Initiative by
Remnant Lipoprotein Cholesterol Levels, Intensive Blood Pressure Treatment, and
Cardiovascular Outcomes: Insights from the SRINT Trial
Gabani M. H.
This study discussed the insights of SPRINT trial .9361 participants were enrolled. Group 1 had 91 events
(4.16%), Group 2 150 events (6.17%), Group 3 128 events (5.84%), and Group 4 had 184 events (7.60%).
Hazard ratios (HR, 95% CI) determined using Cox regression, adjusting for age, race, sex, smoking, BMI,
statins, and fasting glucose. Compared to Group 1, HR for Group 2 (HR=1.64, 1.25-2.14, p=0.0003), Group 3
(HR=1.43, 1.08-1.88, p=0.0101), and Group 4 (HR=2.05, 1.58-2.65, p<.0001). Elevated RLP-C is associated
with adverse CV outcomes, especially with standard BP treatment. RLP-C may serve as a prognostic
biomarker for personalized BP management.
Efficacy and Safety of Fixed Dose Combination Therapy of Low Intensity Rosuvastatin
and Ezetimibe in Hypercholesterolemia Patients
Yang I. H.
This study compared the safety and efficacy of the combination therapy of low intensity rosuvastatin and
ezetimibe with moderate intensity rosuvastatin monotherapy in patients with hypercholesterolemia. This
was a randomized, double-blind, multicenter study conducted in 314 patients. After treatment period,
significant decrease of serum LDL-C level at week 8 was noted in rosuvastatin 2.5mg group than in
ezetimibe 10mg group (rosuvastatin 2.5mg group -30.9±3.2%; ezetimibe 10mg group -16.4±3.4%). The
proportion of patients who achieved target LDL-C level was significantly higher in the rosuvastatin
2.5mg/ezetimibe 10mg group than any other group, including rosuvastatin 5mg group (rosuvastatin
2.5mg/ezetimibe 10mg group 70.1%; rosuvastatin 2.5mg group 39.0%; ezetimibe group 18.2%; rosuvastatin
5mg group 50.0%).The combination of low-intensity rosuvastatin and ezetimibe showed a greater
decrement of serum LDL-C level when compared with moderate-intensity rosuvastatin, with good
tolerance considering adverse events.
A Systematic Analysis of Global Disease Burden of Ischemic Heart Disease From
1990-2019
Khalid N.
This analysis consisted various parameters, including prevalence, incidence, Disability- Adjusted Life
Years (DALY), Years Lived with Disability (YLD), Years of Life Lost (YLL), and other key indicators. The
prevailing trends were delineated. The global IHD mortality rate exhibited an upward trajectory,
increasing from 106.5 in 1990 to 118.1 in 2019. Concurrently, the incidence of IHD displayed a consistent
rise, surging from 219.7 in 1990 to 274.0 in 2019. IHD significantly contributed to the burden of DALY,
reaching a rate of 2352 in 2019, and this trend has been on the rise since 2014. Over the past three
decades, the Global Disease Burden (GBD) of Ischemic Heart Disease (IHD) has shown a steady rise,
mirroring the increase in risk factors. This emphasizes the critical necessity for immediate interventions
and policies geared towards alleviating the growing burden of IHD worldwide.
11. ACC24
April 6 - 8, 2024 Atlanta
In the management of Hypertension, Angina, CAD, Post MI, AF, HF In ACS, High Risk CAD & Post PCI
Scientific Initiative by
Cholesterol and Statin Use Trends in A CABG Population: Insights from A Large
Integrated Healthcare System
Pruzansky AJ
The study assessed the patterns in cholesterol levels and the utilization of statins within a sizable
cohort undergoing coronary artery bypass grafting (CABG), both with and without subsequent major
adverse cardiovascular events (MACE). The patients with MACE had lower LDL-c levels (90.4 vs. 97.6,
p<0.001) and higher pre-CABG statin usage (78% vs. 74%, p<0.001) in comparison to patients who did
not experience major adverse cardiovascular events (MACE) post-coronary artery bypass grafting
(CABG). A target LDL-c < 70 mg/dL was achieved by fewer patients with MACE as compared to those
without MACE. Although the CABG group without subsequent major adverse cardiovascular events
(MACE) initially presented with higher baseline LDL-c values, they demonstrated lower LDL-c levels and
higher statin usage during the 12-year follow-up period.
Understanding the Importance of Age in Selecting a Testing Strategy for Stable
Symptomatic Patients with Suspected Coronary Artery Disease: A Prespecified
Analysis from the PRECISE Randomized Trial
Vemmou E.
The study evaluated the importance of age in selecting a testing strategy (a precise evaluation vs. usual
care) for stable symptomatic patients with suspected coronary artery disease. The rates of the primary
endpoint were lower with a precision evaluation compared to usual care, in both younger and older
patients. A positive computed tomography angiography (CTA) result was linked to catheterization,
demonstrating obstructive coronary artery disease (CAD) in most patients across both age groups. In
contrast, a positive stress test was associated with low rates of obstructive CAD in both age groups. In
this study, a superior performance was demonstrated by CTA±FFR as compared to conventional testing
for both younger and older patients.
Plant-based diets: Prevention for Many, But Not for All! - A Case of Sitosterolemia
Presenting as Elevated Lipids After Initiation of a Plant-based Diet
Mcsurdy K.
The session explored a case study of 57-year-old female with a family history of premature coronary artery
disease presented to clinic for evaluation of hyperlipidemia. The total cholesterol (Tc) was 266, HDL 78,
calculated LDL 171, and triglycerides (TAG) 86. Following the initiation of Rosuvastatin and Ezetimibe, there was
notable enhancement in her lipid profile: Tc 187, LDL 83, HDL 89, and TAG 86. However, two months later, the
patient experienced malaise, myalgias, and elevated transaminases were observed in the hepatic function
panel. Consequently, Rosuvastatin and Ezetimibe were discontinued. The patient opted for a plant-based diet
to manage her lipid levels while refraining from medical therapy. 2 months later, transaminases normalized and
Rosuvastatin was resumed. Rosuvastatin was discontinued, Ezetimibe was reintroduced, and a diet restricted
in plant sterols was commenced. A follow-up lipid panel conducted three months later revealed a restoration
to her previously enhanced lipid levels. Sitosterolemia, though rare, is likely not given due recognition as a
genetic disorder affecting both the absorption and excretion of cholesterol.
12. Scientific Initiative by
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201 B/1, Western Express Highway, Goregaon -East, Mumbai - 400 063, India.
In the management of Hypertension, Angina, CAD, Post MI, AF, HF
In ACS, High Risk CAD & Post PCI
Source: https://accscientificsession.acc.org
Accessed on 7 April 2024
