▎ WuXi AppTec content team editor
Recently, the American Heart Association (AHA) selected important medical advances in the field of heart disease and stroke in 2020. These studies bring new insights into the prevention and treatment of cardiovascular health problems .
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1. Walking is good for health
Two important studies have highlighted the potential benefits of walking more every day. A large-scale study published by
in the Journal of the American Medical Association (JAMA) followed up a representative population of American adults for up to 10 years and found that a higher number of steps per day was associated with a lower overall risk of death. Compared with walking 4,000 steps a day, the risk of all-cause death for people who walked to 8,000 steps a day was significantly reduced by 51%, and the risk of all-cause death for people who walked to 12,000 steps a day was reduced by 65%.
AHA journal Circulation Research published a sub-study of the Framingham Heart Study, which showed that for every 1,000 more steps per day recorded by smart watches, the estimated cardiovascular risk in the next ten years is reduced by 0.18%.
2. Should I use stents or bypass surgery for coronary heart disease?
Coronary heart disease is one of the most common heart diseases. The blood supply of the heart is affected by the narrowing of blood vessels. For patients with stable coronary heart disease and , the main goal of treatment is to prevent disease progression and reduce the risk of death and ischemic events. On the basis of lifestyle and drug intervention, the additional benefits of revascularization (interventional therapy implantation of stents or bypass surgery) have been controversial for many years.
The large-scale study of ISCHEMIA covers more than 5,000 patients in 37 countries, and its milestone results were published in the New England Journal of Medicine (NEJM) in 4 papers. The trial showed that compared with only receiving lifestyle and drug interventions, additional revascularization at did not significantly reduce the risk of myocardial infarction and death, but it better relieves symptoms and improves quality of life. In a sub-study of patients with chronic kidney disease, compared with conservative treatment, increasing revascularization did not reduce the risk of death or myocardial infarction, nor did it improve the quality of life, regardless of whether the patient had angina.
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3. Hypoglycemic drugs used for cardiovascular and nephropathy
A number of studies published in NEJM in 2020 once again emphasized the benefits of SGLT2 inhibitor drugs. In addition to the treatment of type 2 diabetes, these drugs can also reduce Severe kidney problems and heart failure were hospitalized. In the
DAPA-CKD trial, 4304 subjects (about 1/3 of whom had no diabetes) received a median follow-up of 2.4 years. In the dapagliflozin group, the risk of renal function decline, or end-stage renal disease, or death due to renal or cardiovascular causes was significantly reduced by 39%. In the
EMPEROR-Reduced trial, on the basis of conventional heart failure treatment, more than 3,700 patients received empagliflozin or placebo treatment, with an average treatment course of 16 months. In the empagliflozin group, the risk of hospitalization due to worsening heart failure or death from cardiovascular disease was significantly reduced by 25%. Two other trials of
support the benefits of sotagliflozin, a dual inhibitor of SGLT1/2. In patients with type 2 diabetes with chronic kidney disease and cardiovascular disease risk, sotagliflozin significantly reduced the combined risk of death from cardiovascular causes, hospitalization for heart failure, or emergency department due to heart failure by 26%. Among patients hospitalized with type 2 diabetes and recent worsening of heart failure, the risk of death from cardiovascular causes, rehospitalization and emergency room due to heart failure in the sotagliflozin group was significantly reduced by 33%.
4. Breakthrough therapy to control cholesterol levels
Important advances in cholesterol-lowering management in 2020 include: cutting-edge gene therapy, new insights into the role of lipoprotein (a), and progress in the treatment of homozygous familial hypercholesterolemia.
RNAi therapy inclisiran derived from Nobel Prize technology can prevent the liver from producing PCSK9 protein by regulating gene expression, thereby allowing more LDL receptorsCombined with more LDL, more LDL-C is removed from the blood. The ORION-10 and ORION-11 trials included nearly 3,200 atherosclerotic cardiovascular disease (ASCVD) patients or ASCVD high-risk groups. On average, inclisiran reduced the level of LDL-C in the subjects’ blood by half. LDL-C increased slightly in the placebo group.
lipoprotein (a) is a form of LDL and is associated with cardiovascular diseases, including myocardial infarction, aortic stenosis, and stroke. Z1z lipoprotein (a) levels are largely affected by genetic factors, so reducing this index has long been a challenge for . An international study showed that antisense oligonucleotide therapy AKCEA-APO(a)-LRx can effectively reduce lipoprotein (a) levels after 6-12 months of treatment. The higher the dose, the more obvious the decrease in lipoprotein (a) levels. .
Homozygous familial hypercholesterolemia (HoFH) patients, due to genetic defects, LDL-C levels are often extremely high and difficult to control, and they are prone to early heart disease. In the ELIPSE HoFH trial, 24 weeks of evinacumab treatment reduced the LDL-C levels of HoFH patients by 47%.
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5. Multiple stroke prevention strategies
published in the AHA journal Stroke's ROADSTER 2 study tested the effect of transcarotid revascularization (TCAR). This minimally invasive surgery targets carotid artery stenosis, which is one of the main causes of stroke. The new study called ROADSTER 2 was carried out in nearly 700 patients. After TCAR, only 1.7% of patients had stroke or myocardial infarction or died within 30 days after surgery, which is better than traditional open surgery.
The THALES study published in NEJM shows that is used in patients with recent transient ischemic attack (small stroke) or mild to moderate ischemic stroke. Compared with aspirin monotherapy, aspirin and replacement Grelor combination therapy can reduce the risk of death or stroke within 30 days by 17%.
Another NEJM study (Treat Stroke to Target) showed that after a transient ischemic attack or ischemic stroke, is controlled at 90-110 mg/dL (2.3 mmol/L- 2.8 mmol/L), reduces LDL-C to 70 mg/dL (1.8 mmol/L), which can reduce the risk of major cardiovascular events by 22%.
6. The problem of hypertension has become increasingly prominent
Two studies from the Journal of the American College of Cardiology (JACC) and JAMA highlight the threat of hypertension in the American population. On the one hand, the prevalence of pre-pregnancy hypertension has almost doubled in the past 10 years; on the other hand, the proportion of hypertension control in the American population has declined, reaching 43.7% from 2017 to 2018. Hypertension is a key risk factor for cardiovascular disease, and cardiovascular disease is the main cause of pregnancy-related death. A study published in "Annals of Internal Medicine" (Annals of Internal Medicine) reminds us to pay attention to the rare causes behind hypertension. The Harvard Medical School team's analysis of more than 1,800 adults found that the prevalence of hypertension caused by primary aldosteronism is far underestimated. In fact, about 16%-22% of hypertensive patients in may have this problem. . Moreover, the current commonly used screening index results are not accurate enough.
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7. Unique therapies change the treatment of hypertrophic cardiomyopathy
Approximately 1 out of 500 people have hypertrophic cardiomyopathy (HCM). In HCM patients, the myocardium thickens and hardens, making it difficult for the heart to pump blood. Most patients have obstructive HCM, and the blood flow from the left ventricle to the aorta is blocked. Existing drugs usually do not target specific characteristics of the disease or are difficult for patients to tolerate. The "first-in-class" drug mavacamten targets cells involved in the contractility of the heart muscle. In the multinational phase 3 trial EXPLORER-HCM published in The Lancet, this drug showedThe treatment hopes that compared with placebo, the patient's heart function, exercise performance, symptoms and other health conditions will be significantly improved.
8. Remodeling atrial fibrillation first-line treatment
Atrial fibrillation (atrial fibrillation) can cause arrhythmia. Two new studies (EAST-AFNET 4 and EARLY-AF) published in NEJM show that more aggressive treatment strategies (including medications and ablation) within one year of diagnosis can prevent serious health consequences of atrial fibrillation.
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9. Revealing the mystery of COVID-19
The new coronavirus disease (COVID-19) is undoubtedly the focus of medical research this year. Early findings indicate that cardiovascular complications are common in many COVID-19 patients.
The COVID-19 Cardiovascular Disease Database initiated by AHA has tracked more than 26,000 COVID-19 patients and is answering some important questions. A study of patients in 88 hospitals in the United States showed that Hispanic and black patients are at a high risk of being admitted to the hospital due to COVID-19. Another study found that regardless of age, obesity will lead to a higher risk of complications and death for COVID-19 patients . Compared with people of normal weight, patients with severe obesity (BMI≥40) have more than doubled the risk of requiring a ventilator, and the risk of death in the hospital is also 26% higher.
10. Don’t forget to prevent influenza
Under the new crown epidemic, there are also new studies that reiterate the importance of influenza prevention , especially in high-risk patients including heart disease patients.
A study of more than 80,000 influenza hospitalizations in the Yearbook of Internal Medicine from 2010 to 2018 showed that almost 12% of patients had an acute heart event before discharge, such as acute heart failure, myocardial infarction or hypertension crisis. Of these patients, 31% required intensive care and 7% died. The results of the study emphasize the importance of increasing influenza vaccination rates. A study published in JAMA recently analyzed the data of more than 5,000 North American heart disease patients and found that the high-dose trivalent influenza vaccine is as effective as the standard dose quadrivalent influenza vaccine. But overall it is strongly recommended that patients with heart disease get the flu vaccine.
