On Nov. 10, the American Heart Association (AHA) held its annual Scientific Sessions meeting in Chicago, featuring the latest advances from major cardiovascular trials with the potential to transform clinical practice. Investigators from the Brigham led some of the most highly anticipated trials and presented their results at the conference.
Insights into Omega-3s, Vitamin D
The benefits of omega-3 fatty acids – a “good” fat largely found in fish, nuts, flax seeds and leafy greens – have been touted in recent years. But just how protective are they in cardiovascular health?
Deepak L. Bhatt, MD, MPH, executive director of Interventional Cardiovascular Programs in the Division of Cardiovascular Medicine, presented results and insights from the clinical trial REDUCE-IT, which tested whether icosapent ethyl (a medication derived from an omega-3 fatty acid found in fish oil) could reduce the risk of cardiovascular events in at-risk patients. Participants were defined as “at risk” if they fell into one of two categories. Either they had atherosclerosis – a disease in which plaque builds up in the arteries – or they had diabetes plus at least one other cardiovascular risk factor along with elevated triglyceride levels, despite taking statins.
Participants who took the medication saw a 25 percent risk reduction in cardiovascular events and a 20 percent reduction in death due to cardiovascular causes, a result Bhatt described as “remarkable.”
“This may be the biggest development in cardiovascular prevention since statins,” he said. “The REDUCE-IT trial sets a new standard of care for these patients.”
In another presentation, JoAnn Manson, MD, DrPH, chief of the Division of Preventive Medicine, unpacked results from the VITamin D and OmegA-3 TriaL (VITAL). VITAL also examined whether omega-3 fatty acids affected a person’s risk of experiencing cardiovascular events, but Manson and colleagues studied them among a general, racially diverse population and used a lower-dose supplement that contained both of the major forms of marine omega-3s. VITAL also examined effects on cancer occurrence.
The team found that omega-3s reduced the risk of heart attacks but did not reduce stroke, major cardiovascular events or cancer. VITAL also tested the effects of taking a vitamin D supplement, which did not reduce cardiovascular or cancer outcomes except for a signal that cancer deaths were lower over time.
Diabetes Drug Lowers Heart Failure Risk
A new class of diabetes drugs known as SGLT2 inhibitors can help lower blood glucose levels in patients with diabetes. Investigators are finding mounting evidence that the inhibitors may also lower cardiovascular risk.
Stephen Wiviott, MD, of Cardiovascular Medicine, shared findings from the DECLARE–TIMI 58 trial. The multinational trial tested an SGLT2 inhibitor known as dapagliflozin. Wiviott highlighted reductions in risk of adverse heart and kidney outcomes for patients.
Separately, Elisabetta Patorno, MD, DrPH, of the Division of Pharmacoepidemiology and Pharmacoeconomics, presented initial results from the real-world EMPRISE study, which found that another SGLT2 inhibitor reduced the risk of hospitalization for heart failure in routine care.
Inflammation and Heart Disease: A Roadmap for the Future
Brigham cardiologists have been at the forefront of basic, clinical and translational research linking inflammation and heart disease for decades and presented the next chapter in the ongoing story of the inflammatory hypothesis at this year’s meeting.
Paul Ridker, MD, director of the Center for Cardiovascular Disease Prevention, delivered results from the Cardiovascular Inflammation Reduction Trial (CIRT), a large-scale trial that tested whether low-dose methotrexate – an inexpensive, generic drug widely used to treat inflammatory diseases – was effective in reducing cardiovascular risk.
Last year, the Canakinumab Anti-inflammatory Thrombosis Outcomes Study (CANTOS) showed that the high-cost drug canakinumab targeted a specific inflammatory pathway and consequently lowered rates of heart attack and cardiovascular death. By contrast, the findings from CIRT showed that low-dose methotrexate neither inhibited that same pathway nor did it reduce major adverse cardiovascular event rates.
“The results from CIRT and CANTOS, when considered together, tell us something critically important: Not all inflammation is the same, and not all drugs that target inflammation are the same,” said Ridker. “While it is disappointing that an inexpensive drug like methotrexate did not have the effects we previously saw in CANTOS, the results from CIRT shed crucial light on the underlying biology that connects inflammation with cardiovascular disease. The divergent trial results provide a clear roadmap to guide our efforts going forward.”
In a separate presentation, Brendan Everett, MD, MPH, director of General Cardiology Inpatient Service, reported that the interleukin-1β inhibitor canakinumab reduced hospitalization for heart failure and heart failure-related death. These data represent the first-large scale evidence that inflammation inhibition can improve outcomes in heart failure. The results suggest that the role of inflammation reduction in improving heart failure outcomes merits further exploration.