Technologies that less invasively restore blood flow to blocked or narrowed arteries; a medicine that outsmarts high blood pressure's development; and new evidence that diabetes drugs may offer heart health benefits to people that don't have diabetes are among the news-making scientific research developments in the fight against heart disease and stroke that emerged in 2023. The American Heart Association, the largest non-governmental funder of heart and stroke related research in the United States, has been compiling an annual list of major advances in heart disease and stroke science since 1996.
"Every year, we compile an overview of scientific research that advances our understanding of how to prevent, treat and manage heart disease and stroke. Whether the science points to new ways to treat long-known health conditions, disparities in care or how to prevent some of our most pressing problems, such as high blood pressure, diabetes or obesity, the findings help people, health care professionals, policymakers and others make better informed health care decisions," said Mariell Jessup, M.D., FAHA, chief science and medical officer of the American Heart Association.
A complete review of the Association's top picks for leading cardiovascular-related research can be found here. These are brief summaries of the most significant developments from 2023:
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Outsmarting high blood pressure's development with new drug.
Despite advances in medications that aim to control already high blood pressure, fewer than 25% of those people being treated are able to keep blood pressure levels within the target range below 130/80 mmHg. Looking for a new approach to prevent high blood pressure, researchers studied Zilebesiran, an investigational medication that decreases the body's production of angiotensinogen. Angiotensinogen, a protein secreted by the liver, is believed to play a key role in increasing blood pressure. They found people taking Zilebesiran saw reductions in their blood pressure, with higher doses of the medication resulting in greater reductions.
- Minimally invasive thrombectomy benefits even the most severe stroke patients. Endovascular thrombectomy is a minimally invasive surgical procedure used to remove a stroke-causing blood clot from an artery in the brain. It restores blood flow and prevents further brain damage and disability and is standard treatment for small or medium-sized strokes. Until now, it wasn't clear if endovascular thrombectomy would also benefit people with larger, more severe strokes, which account for up to one-fourth of all strokes. In a study of people with severe strokes from China and in another trial of people in North America, Europe, Australia and New Zealand, researchers found endovascular thrombectomy within 24 hours of a stroke was superior to standard medical care. Those receiving thrombectomies experienced fewer disabilities and were more functionally independent during the three months after treatment. A third study of people treated for severe stroke in Europe and Canada found much the same, showing those who underwent endovascular thrombectomy were more functionally independent than those who had standard medical treatment, alone. This study also showed that thrombectomy patients were less likely to die.
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Imaging advances help guide stent placement in complex procedures.
Percutaneous coronary intervention, or PCI, is a non-surgical procedure used to place a stent in blood vessels in the heart that have become blocked or too narrow. Initially, PCI was reserved for people with simple coronary artery disease. However, four recent studies comparing the safety and effectiveness of different imaging used to guide stent placement suggest PCI might benefit people with more complex (harder to reach) heart problems using a newer imaging approach. The ILUMIEN IV study found that optical coherence tomography guided PCI, a type of intravascular imaging that uses light waves to look more closely at arterial plaque, outperformed angiography guided PCI. Angiography, typically called cardiac catheterization, is a type of X-ray used to look inside blood vessels after a special dye is injected into the blood to make it easier to see problems. The OCTOBER trial compared the same methods for people with plaque build-up in areas that are difficult to see. Over two years of follow-up, people who had optical coherence tomography-guided PCI had fewer major cardiac events and deaths. The RENOVATE-COMPLEX-PCI study compared intravascular imaging-guided PCI including ultrasonography (using sound waves) or optical coherence tomography to angiography-guided PCI and found over two years of follow-up that people treated with either type of intravascular imaging-guided PCI had fewer heart-related deaths, heart attacks or need for further revascularization. And the OCTIVUS trial, published in the American Heart Association's flagship journal, Circulation, compared the safety and effectiveness of the two types of intravascular image guidance and found both were equally safe and effective.
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Starting anticoagulant drugs for AFib patients following a stroke is better sooner than later.
Health care professionals generally treat people with atrial fibrillation (AFib) who have had a stroke with direct-acting oral anticoagulants (DOAC), which are quick-acting blood thinners that help prevent strokes from occurring. European guidelines suggest starting DOAC treatment three days after a minor stroke, six days after a moderate stroke and 12 days after a severe stroke. The American Heart Association/American Stroke Association guidelines suggest waiting more than two weeks in some high-risk patients. A new study suggests that starting treatment with DOACs sooner might be better. Researchers compared early anti-coagulation treatment (within 48 hours of a minor or moderate stroke and on day six or seven following a major stroke) to different lengths of later treatment following those stroke types in people AFib. The aim of the trial was to help health care professionals better estimate possible results from timing treatment. Researchers measured stroke size and severity using CT or MRI scans rather than standard scoring measurements and found the imaging allowed them to better identify who could benefit from earlier DOAC treatment. They also found that earlier treatment resulted in a lower recurrent stroke risk and slightly lower bleeding risk outside the brain in the month following a stroke.
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Diabetes drugs may offer heart health benefits to people who don't have diabetes.
Glucose-lowering drugs have changed the landscape for people with type 2 diabetes, reducing cardiovascular events and improving heart health. A growing number of studies suggest these drugs may also improve heart health in obese people who don't have diabetes. In one trial of semaglutide, a medication shown to lower the risk of heart problems in people with diabetes and approved for long-term weight management, people with heart failure with preserved ejection fraction and obesity fared better on the drug than on placebo. (Preserved ejection fraction (HFpEF) happens when the heart muscle becomes thick and/or stiff and can't pump out enough blood to meet the body's needs.) The semaglutide group had greater reductions in heart failure-related symptoms, greater improvements in the ability to exercise and greater weight loss. In a late-breaking trial presented at the American Heart Association's Scientific Sessions 2023, researchers investigating whether semaglutide benefits overweight and obese people who didn't have diabetes but who had cardiovascular disease found the drug superior to placebo in reducing cardiovascular-related death, nonfatal heart attacks and nonfatal strokes.
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Social determinants of health fuel disparities in cardiovascular death rates.
A growing body of research highlights how social determinants of health may play a role in why some groups of people are more likely to have and die from heart disease than others. In a study published in the Journal of the American Heart Association, researchers found that while cardiovascular death rates were declining overall across the U.S., they remained higher in rural counties and in counties with a higher percentage of Black residents. Cardiovascular death rates were linked to such factors as income status and access to healthy foods and housing. The likelihood of receiving life-saving CPR after experiencing an out-of-hospital cardiac arrest was lower for Black and Hispanic people, according to another study.
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Study of nearly 120,000 people shows healthy eating lowers risk of death.
Researchers studying the eating pattens of nearly 120,000 adult men and women found a strong link between adherence to a variety of healthy eating patterns aligned with USDA dietary guidelines and a lower death risk. The link was consistent across racial and ethnic groups.
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Understanding a new public health priority: CKM syndrome--the link between cardiovascular, kidney disease and metabolic syndrome.
A 2023 American Heart Association Scientific Statement summarizes cardiovascular-kidney-metabolic (CKM) syndrome, an interconnection between obesity, chronic kidney disease, diabetes and cardiovascular disease, which is linked to premature death and disability. The statement summarizes what is known about CKM syndrome and how to prevent and manage it. It highlights a new way to calculate risk of the syndrome, as well as gaps in knowledge and needed research. An accompanying Presidential Advisory helps define CKM syndrome and offers guidance on the prevention and treatment of the syndrome across different clinical and community settings.
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Is a less-invasive treatment better for people with limb-threatening PAD than surgical vein bypass?
Two studies compared less invasive endovascular therapy to bypass surgery for the treatment of chronic limb-threatening ischemia, an advanced form of peripheral arterial disease (PAD). The findings suggest the choice of intervention should be based on shared decision making between the patient and their interventional cardiologists and vascular surgeons. BASIL-2 compared the effectiveness of a vein bypass to angioplasty in men and women with severe ischemia in the United Kingdom, Sweden and Denmark. People who received the endovascular treatment had greater amputation-free survival. But an accompanying editorial noted these results may have been skewed by the COVID-19 pandemic, which could have limited the number of follow-up visits and boosted the death rate. The BEST-CLI study compared bypass surgery to endovascular therapy in two groups of patients: one with a greater saphenous vein (the large vein that runs the length of the lower leg) that was suitable for surgery and another group who needed an alternative type of bypass. The study including patients in the U.S., Canada, Finland, Italy and New Zealand found that surgery resulted in fewer amputations and deaths among those with a greater saphenous vein. But there were no notable differences in results among the other groups.
