Jamal S. Rana, MD, PhD, from Kaiser Permanente Northern California in Oakland, and colleagues examined whether or not heavy episodic drinking days (HED; i.e., “binge” drinking), in conjunction with habitual drinking, impacts CVD risk among US adults. The analysis included 697,985 adults (43% women) who, in 2014 to 2015, reported drinking alcohol as part of regular health care screening.

The researchers found that for men and women (aged 18 to 65 years), those with high total consumption (≥15 drinks/week for men; 8 or more drinks/week for women) had higher odds of CVD compared with those with moderate (3 to 14 drinks/week for men; 3 to 7 drinks/week for women) or low (1 to 2 drinks/week for men or women) consumption. Associations were stronger among those reporting any HED (5 or more drinks on any day in past 3 months for men and 4 or more for women; 20.8%). For men older than 65 years, CVD risk was not increased with or without HED. For women older than 65 years and HED, moderate and high total consumptions more than doubled the odds of CVD vs that seen with low consumption.

“Women feel they’re protected against heart disease until they’re older, but this study shows that even when you’re young or middle aged, if you are a heavy alcohol user or binge drink, you are at risk for coronary heart disease,” Rana said in a statement.

Press Release

More Information

HealthDay News — A coordinated, multifaceted intervention increases prescription of 3 groups of evidence-based therapies in adults with type 2 diabetes and atherosclerotic cardiovascular disease (CVD), according to a study published online March 6 in the Journal of the American Medical Association to coincide with the annual meeting of the American College of Cardiology, held from March 4 to 6 in New Orleans.

Neha J. Pagidipati, MD, MPH, from the Duke Clinical Research Institute in Durham, North Carolina, and colleagues assessed the effect of a coordinated, multifaceted intervention of assessment, education, and feedback vs usual care on the proportion of adults with type 2 diabetes and atherosclerotic CVD prescribed all 3 groups of recommended, evidence-based therapies (high-intensity statins, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers [ACEIs or ARBs], and sodium-glucose cotransporter 2 inhibitors and/or glucagon-like peptide 1 receptor agonists [SGLT2 inhibitors and/or GLP-1RAs]). The analysis included 1049 participants treated at 43 US cardiology clinics (July 2019 through May 2022).

The researchers found that patients in the intervention group were more likely to be prescribed all 3 therapies (37.9%) vs individuals in the usual-care group (14.5%; adjusted odds ratio, 4.38) and were more likely to be prescribed each of the three therapies (adjusted odds ratios, 1.73, 1.82, and 3.11 for high-intensity statins, ACEIs or ARBs, and SGLT2 inhibitors and/or GLP-1RAs, respectively). No changes in atherosclerotic CVD risk factors were seen with the intervention.

“An absolute increase of 23.4 percent in prescriptions for all three recommended therapies in the intervention group versus the usual-care group, which was more than twice the improvement the trial was designed to detect, is clinically meaningful and, based on clinical trial evidence for these therapies, should result in a substantial improvement in patient outcomes over time,” the authors write.

Several authors disclosed financial ties to the pharmaceutical industry.

Abstract/Full Text (subscription or payment may be required)

More Information

Adrian Hernandez, MD, from Duke University in Durham, North Carolina, and colleagues examined the impact of empagliflozin on first and recurrent heart failure events in patients after myocardial infarction in a double-blind, randomized trial. The study included 6522 patients hospitalized for acute myocardial infarction at risk for heart failure based on newly developed left ventricular ejection fraction of <45% and/or signs or symptoms of congestion.

The researchers found that the risk for first heart failure hospitalization and total heart failure hospitalizations was significantly lower in the empagliflozin group vs the placebo group during a median follow-up of 17.9 months (hazard ratio, 0.77 for first heart failure hospitalization; rate ratio, 0.67 for total heart failure hospitalizations).

For first and total heart failure hospitalizations, the benefit of empagliflozin was consistent across clinically relevant patient subgroups. Patients randomly assigned to empagliflozin had less postdischarge need for new use of diuretics, renin-angiotensin modulators, and mineralocorticoid receptor antagonists.

“These data suggest the potential role for empagliflozin in high-risk post-myocardial infarction patients in preventing heart failure hospitalizations,” the authors write.

Several authors disclosed ties to biopharmaceutical companies, including Boehringer Ingelheim and Eli Lilly, which manufacture empagliflozin and funded the study.

Abstract/Full Text

More Information

Javed Butler, MD, MPH, from the Baylor Scott and White Research Institute in Dallas, and colleagues randomly assigned patients hospitalized for acute myocardial infarction who were at risk for heart failure to empagliflozin 10mg daily or placebo in addition to standard care within 14 days after admission (3260 and 3262 patients, respectively).

The researchers found that a first hospitalization for heart failure or death from any cause occurred in 8.2 and 9.1% of patients in the empagliflozin and placebo groups, respectively, during a median follow-up of 17.9 months (incidence rates, 5.9 and 6.6 events, respectively, per 100 patient-years; hazard ratio, 0.90; 95% CI, 0.76 to 1.06; P =.21). A first hospitalization for heart failure occurred in 3.6 and 4.7% of patients in the empagliflozin and placebo groups, respectively (hazard ratio, 0.77; 95% CI, 0.60 to 0.98), and death from any cause occurred in 5.2 and 5.5%, respectively (hazard ratio, 0.96; 95% CI, 0.78 to 1.19). Adverse events were consistent with the known safety profile for empagliflozin.

“Empagliflozin did not reduce the risk of the composite primary end point event, a first hospitalization for heart failure or death from any cause, in patients with acute myocardial infarction who were at increased risk for heart failure,” the authors write.

Several authors disclosed ties to pharmaceutical companies, including Boehringer Ingelheim and Eli Lilly, which manufacture empagliflozin and funded the study.

Abstract/Full Text (subscription or payment may be required)

More Information

HealthDay News — A low dietary sodium diet, including intake below the standard recommended maximum of 2.3g per day, is associated with an increased risk for in-hospital mortality among patients with heart failure, according to a study presented at the annual meeting of the American College of Cardiology, held from March 4 to 6 in New Orleans.

Anirudh Palicherla, MD, from the Creighton University School of Medicine in Omaha, Nebraska, and colleagues conducted a meta-analysis of randomized clinical trials to compare low dietary sodium to usual care in heart failure. Data were included from 9 studies with 3499 patients.

The researchers found that the low dietary sodium group showed a significant increase in in-hospital mortality compared with usual care (risk ratio, 1.84 [95% CI, 1.46 to 2.31; P <.001] for intake <2.5g/day vs ≥2.5g/day). No significant difference was seen between the groups in hospitalization (risk ratio, 1.45; 95% CI, 0.99 to 2.11; P =.05).

“Our findings showed that restricting dietary sodium to less than the usual recommendation was counterproductive in the management of heart failure,” Palicherla said in a statement. “This study shows that the focus should be on establishing a safe level of sodium consumption instead of overly restricting sodium.”

Press Release

More Information

Mikhail N. Kosiborod, MD, from Saint Luke’s Mid America Heart Institute in Kansas City, Missouri, and colleagues randomly assigned 616 patients who had heart failure with preserved ejection fraction, a body mass index of 30 kg/m² or more, and type 2 diabetes to receive semaglutide or placebo once a week for 52 weeks. The change from baseline in the Kansas City Cardiomyopathy Questionnaire clinical summary score (KCCQ-CSS) and change in body weight were the primary endpoints.

The researchers found that the mean change in KCCQ-CSS was 13.7 and 6.4 points with semaglutide and placebo, respectively, and the corresponding mean percentage changes in body weight were −9.8% and −3.4%. For the confirmatory secondary endpoints, including the estimated between-group difference in change in 6-minute walk distance and estimated treatment ratio for change in C-reactive protein level, the results favored semaglutide over placebo. Serious adverse events were reported in 17.7% and 28.8% of those in the semaglutide and placebo groups, respectively.

“Once-weekly semaglutide at a dose of 2.4 mg led to larger reductions in heart failure-related symptoms and physical limitations and greater weight loss than placebo at 52 weeks,” the authors write.

Several authors disclosed ties to biopharmaceutical companies, including Novo Nordisk, which manufactures semaglutide and funded the study.

Abstract/Full Text (subscription or payment may be required)

More Information

HealthDay News — Sotatercept is associated with a greater improvement in exercise capacity than placebo among patients with pulmonary arterial hypertension (PAH) receiving stable background therapy, according to a study published online March 6 in the New England Journal of Medicine to coincide with the annual meeting of the American College of Cardiology, held from March 4 to 6 in New Orleans.

Marius M. Hoeper, MD, from Hannover Medical School in Germany, and colleagues randomly assigned (1:1) adults with PAH (World Health Organization functional class II or III), who were receiving stable background therapy, to receive subcutaneous sotatercept (163 patients; starting dose, 0.3mg per kg of body weight; target dose, 0.7mg per kg) or placebo (160 patients) every 3 weeks.

The researchers found that the median change from baseline to week 24 in the 6-minute walk distance was 34.4 m (95% CI, 33.0 to 35.5) in the sotatercept group and 1.0 m (95% CI, −0.3 to 3.5) in the placebo group, yielding a Hodges-Lehmann estimate of the difference between the groups of 40.8 m. Eight of 9 secondary end points were significantly improved with sotatercept vs placebo, but the cognitive-emotional impacts domain of the Pulmonary Arterial Hypertension-Symptoms and Impact Physical Impacts, Cardiopulmonary Symptoms score was not different between the groups. Adverse events, including epistaxis, dizziness, telangiectasia, increased hemoglobin levels, thrombocytopenia, and increased blood pressure, occurred more frequently with sotatercept than placebo.

“This is the most impressive reduction in the pulmonary arterial pressure that we’ve ever seen in pretreated patients with PAH,” Hoeper said in a statement. “For me, it’s one of the strongest signals suggesting that we truly achieved some regression of the disease’s adverse changes in the pulmonary vessels.”

Acceleron Pharma supported the study. Acceleron is owned by Merck, the manufacturer of sotatercept.

Abstract/Full Text (subscription or payment may be required)

Editorial (subscription or payment may be required)

More Information

HealthDay News — For patients with coronary artery disease, a treat-to-target low-density lipoprotein cholesterol (LDL-C) strategy is noninferior to high-intensity statin therapy, according to a study published online March 6 in the Journal of the American Medical Association to coincide with the annual meeting of the American College of Cardiology, held from March 4 to 6 in New Orleans.

Sung-Jin Hong, MD, from the Yonsei University College of Medicine in Seoul, South Korea, and colleagues examined whether a treat-to-target strategy is noninferior to a strategy of high-intensity statins for long-term outcomes among patients with coronary artery disease from 12 centers. Participants were randomly assigned to receive the treat-to-target strategy, with a target LDL-C level between 50 and 70mg/dL or high-intensity statin treatment of 20mg rosuvastatin or 40mg atorvastatin.

A total of 4400 patients were enrolled (2200 in the treat-to-target group, with 6449 person-years of follow-up). The researchers found that moderate-intensity and high-intensity dosing were used in 43 and 54% of patients in the treat-to-target group. The mean LDL-C level for three years was 69.1 and 68.4mg/dL in the treat-to-target and high-intensity statin groups, respectively. The primary end point (three-year composite of death, myocardial infarction, stroke, or coronary revascularization with a noninferiority margin of 3.0 percentage points) occurred in 8.1 and 8.7% of patients in the treat-to-target and high-intensity statin groups, respectively.

“These findings provide additional evidence supporting the suitability of a treat-to-target strategy that may allow a tailored approach with consideration for individual variability in drug response to statin therapy,” the authors write.

One author disclosed financial ties to the pharmaceutical and medical device industries.

Abstract/Full Text

More Information

Acoramidis is an orally-administered small molecule designed to stabilize tetrameric transthyretin (TTR). The NDA is supported by data from the randomized, double-blind, placebo-controlled phase 3 ATTRibute-CM trial (ClinicalTrials.gov Identifier: NCT03860935), which evaluated the efficacy and safety of acoramidis in 632 adults with symptomatic ATTR-CM. 

Study participants were randomly assigned 2:1 to receive acoramidis 800mg orally twice daily or placebo for 30 months. The primary endpoint of the study was a 4-step hierarchical combination of all-cause mortality, cumulative frequency of cardiovascular-related hospitalization, change from baseline in N-terminal pro–B-type natriuretic peptide (NT-proBNP), and change from baseline in 6-minute walk distance over a 30-month fixed treatment duration. 

Results showed a statistically significant improvement with acoramidis compared with placebo for the primary endpoint, with a win ratio of 1.8 (95% CI, 1.4-2.2; P <.0001). “Together, death from any cause and cardiovascular-related hospitalization contributed more than half the wins and losses to the win ratio (58% of all pairwise comparisons); NT-proBNP pairwise comparisons yielded the highest ratio of wins to losses (23.3% vs. 7.0%),” explained the study authors. Adverse events were found to be similar between the groups.

A Prescription Drug User Fee Act target date of November 29, 2024 has been set for the application.

Kim L. Feingold, PhD, from Northwestern University Feinberg School of Medicine in Chicago, and colleagues randomly assigned (1:1) patients undergoing primary valve surgery via sternotomy to acupuncture (51 individuals) or standard care (49 individuals). Daily inpatient acupuncture sessions started on postoperative day 1.

The researchers found that an average of 3.8 acupuncture sessions were delivered per patient during a mean hospital stay of 4.6 days. Acupuncture was associated with lower pain, nausea, stress, and anxiety after each session and across admission vs standard care. Additionally, acupuncture was associated with a lower incidence of postoperative atrial fibrillation (acupuncture, 13.7%; standard care, 32.7%), fewer discharges on amiodarone (acupuncture, 9.8%; standard care, 26.5%), and fewer hours in the intensive care unit (acupuncture, 30.3; standard care, 37.0).

“We learned that acupuncture after open heart surgery is feasible in this fast-paced environment, even in the intensive care unit the day after surgery, and was well tolerated by patients with no adverse effects,” Feingold said in a statement. “The majority of patients had no prior history with acupuncture, demonstrating their openness to receive integrative therapies after surgery. Overall, patients reported that it was a pleasant and positive aspect of their cardiovascular surgery recovery.”

Several authors disclosed ties to the medical technology industry.

Abstract/Full Text

Rebecca C. Woodruff, PhD, MPH, from the US Centers for Disease Control and Prevention in Atlanta, and colleagues conducted a cross-sectional study examining surveillance data from the RSV Hospitalization Surveillance Network. To estimate the weighted period prevalence of acute cardiac events, cases of RSV infection in adults aged 50 years and older within 12 states over 5 RSV seasons were examined.

A total of 6248 hospitalized adults with laboratory-confirmed RSV infection were included. The researchers found that the weighted estimated prevalence of experiencing a cardiac event was 22.4%, with weighted estimated prevalence of 15.8, 7.5, 1.3, 1.1, and 0.6% for acute heart failure, acute ischemic heart disease, hypertensive crisis, ventricular tachycardia, and cardiogenic shock, respectively. The risk for experiencing an acute cardiac event was higher for adults with underlying cardiovascular disease (33.0 vs 8.5%; adjusted risk ratio [aRR], 3.51). Of the hospitalized adults with RSV infection, 18.6 and 4.9% required intensive care unit (ICU) admission and died, respectively; those who experienced an acute cardiac event had higher risks for ICU admission and in-hospital death (aRRs, 1.54 and 1.77, respectively).

“Acute cardiac events contribute substantially to the burden of RSV disease; whether RSV vaccination can prevent these complications is an important question as the impact of these vaccines is evaluated,” the authors write.

Abstract/Full Text (subscription or payment may be required)

Editor’s Note (subscription or payment may be required)

HealthDay News — Bempedoic acid is associated with a reduction in major adverse cardiovascular events among statin-intolerant primary prevention patients, according to a study published online June 24 in the Journal of the American Medical Association to coincide with the annual meeting of the American Diabetes Association, held from June 23 to 26 in San Diego.

Steven E. Nissen, MD, from the Cleveland Clinic, and colleagues conducted a masked, randomized trial involving 13,970 statin-intolerant patients, including 4206 primary prevention patients to determine the effects of bempedoic acid on cardiovascular outcomes. Participants were randomly assigned to oral bempedoic acid or matching placebo (2100 and 2106 patients, respectively).

The researchers found that bempedoic acid reduced low-density lipoprotein cholesterol levels by 30.2mg/dL and high-sensitivity C-reactive protein levels by 0.56mg/L compared with placebo (reductions of 21.3 and 21.5%, respectively). A significant risk reduction was seen in the primary end point of first occurrence of any component of a composite of cardiovascular death, nonfatal myocardial infarction (MI), nonfatal stroke, or coronary revascularization (111 vs 161 events [5.3 vs 7.6%; adjusted hazard ratio, 0.70]) during follow-up for a median of 39.9 months. Significant risk reductions were also seen in key secondary end points, including the composite of cardiovascular death, MI, or stroke; MI; cardiovascular death; and all-cause mortality (hazard ratios, 0.64, 0.61, 0.61, and 0.73, respectively).

“Administration of bempedoic acid in patients unable or unwilling to take guideline recommended doses of a statin was associated with a significant reduction in the primary end point, four-component major adverse cardiovascular events,” the authors write.

Several authors disclosed ties to pharmaceutical companies, including Esperion Therapeutics, which manufactures bempedoic acid and funded the study.

Abstract/Full Text

Editorial

More Information

HealthDay News — For individuals with diabetes without preexisting cardiovascular disease, the addition of glucagon-like peptide 1 receptor agonists (GLP1-RA) is associated with a lower risk for major adverse cardiac events (MACE) and heart failure, according to a study published online May 9 in the Annals of Internal Medicine.

Tadarro L. Richardson Jr., MD, from the VA Tennessee Valley Healthcare System Geriatric Research Education Clinical Center in Nashville, and colleagues examined whether MACE incidence is lower with the addition of GLP1-RA or sodium-glucose cotransporter 2 inhibitors (SGLT2i) vs dipeptidyl peptidase-4 inhibitors (DPP4i) onto metformin, sulfonylurea, or insulin treatment alone or in combination. A total of 28,759 GLP1-RA versus 28,628 DPP4i weighted pairs and 21,200 SGLT2i vs 21,170 DPP4i weighted pairs were included in the study.

The researchers found lower MACE and heart failure risk in association with GLP1-RA vs DPP4i (adjusted hazard ratio, 0.82; 95% CI, 0.72 to 0.94), for an adjusted risk difference of 3.2 events per 1000 person-years. There was no association observed for SGLT2i versus DPP4i with MACE and heart failure (adjusted hazard ratio, 0.91; 95% CI, 0.78 to 1.08).

“These findings are hypothesis generating, and further evaluation of these medications as part of primary [cardiovascular disease] prevention strategy is needed,” the authors write.

Abstract/Full Text (subscription or payment may be required)

Editorial (subscription or payment may be required)

HealthDay News — For women, adherence to a Mediterranean diet is associated with a reduced risk for cardiovascular disease (CVD) and mortality, according to a review published online March 14 in Heart.

Anushriya Pant, from the University of Sydney, and colleagues examined the association between higher vs lower adherence to a Mediterranean diet and incident CVD and total mortality among women in a systematic review and meta-analysis. The meta-analysis included 16 prospective cohort studies with 722,495 female participants.

The researchers found that higher adherence to a Mediterranean diet was associated with lower CVD incidence, total mortality, and coronary heart disease (hazard ratios [95% CI], 0.76 [0.72 to 0.81], 0.77 [0.74 to 0.80], and 0.75 [0.65 to 0.87], respectively). Women with higher Mediterranean diet adherence had lower stroke incidence, but the reduction was not statistically significant (hazard ratio, 0.87; 95% CI, 0.76 to 1.01).

“Future research might consider adding more studies that look at the dietary impact on stroke, and subgroup analyses that address female specific cardiovascular risk factors, menopausal status and ethnicity, as well as individual participant data meta-analyses,” the authors write.

Abstract/Full Text