Brigham and Women’s Cardiologists Present Advancements at AHA Scientific Sessions 2019

This November, leading experts in cardiology from Brigham and Women’s Hospital presented new findings and cutting-edge research at the American Heart Association’s (AHA) Scientific Sessions 2019 in Philadelphia.

Effect of Sacubitril/Valsartan Across the Spectrum of Ejection Fraction in Heart Failure

Scott Solomon, MD, the Frohlich Distinguished Chair at Brigham and Women’s Hospital, and co-chair of PARAGON-HF, presented findings that showed the benefits of sacubitril/valsartan appeared to extend beyond heart failure patients with reduced ejection fraction to those with higher ejection fractions just below normal limits. In pooled analysis of 13,195 patients with heart failure across the spectrum of ejection fraction from both the PARADIGM and PARAGON trials, researchers observed 16 percent reduction in first cardiovascular death or heart failure hospitalization, 19 percent reduction in total heart failure hospitalizations, and 12 percent reduction in all-cause mortality in patients randomized to sacubitril/valsartan compared with a renin-angiotensin system inhibitor. More details in Circulation.

REDUCE-IT USA Results Show 30 Percent Relative Risk Reduction and 2.6 Percent Absolute Risk Reduction in All-cause Mortality

Deepak L Bhatt, MD, MPH, executive director of Interventional Cardiovascular Programs at Brigham Health and chair and Global International Principal Investigator of landmark Reduction of Cardiovascular Events with Icosapent Ethyl – Intervention Trial (REDUCE-IT), offered results of a subgroup analysis of REDUCE-IT, known as REDUCE IT-USA.

REDUCE IT-USA aimed to determine the degree of benefit of icosapent ethyl in patients in the United States. Dr. Bhatt reported significant reductions in primary and secondary endpoints, including a 30 percent relative risk reduction and 2.6 percent absolute risk reduction in all-cause mortality. More details in Circulation.

This year, the REDUCE-IT trial findings led to an FDA Advisory Committee’s unanimous recommendation to approve expanding the indication for the prescription heart drug, icosapent ethyl, a pure and stable form of the omega-3 fatty acid known as EPA, shown in REDUCE-IT to reduce the risk of cardiovascular events.

Use of a Genetic Risk Score to Predict Coronary and Vascular Events and Benefit From Evolocumab Therapy in Patients With Atherosclerotic Disease From the FOURIER Trial

Nicholas Marston, MD, presented an analysis of patients from the FOURIER (Further Cardiovascular Outcomes Research with PCSK9 Inhibition in Subjects with Elevated Risk) trial. Using genetic risk scores, the team examined subsets of patients who were significantly at risk for recurrent cardiovascular events and identified individuals who derived greater benefit from evolocumab, a PCSK9 inhibitor. More details in Circulation.

Navigator-Led Remote Optimization of Guideline-Directed Medical Therapy in Patients With Heart Failure With Reduced Ejection Fraction

Akshay Desai, MD, and colleagues examined whether an algorithm-driven, navigator-administered medication optimization program could enhance implementation of guideline-directed medical therapy (GDMT) compared with usual care in patients with heart failure with reduced ejection fraction (HFrEF). Dr. Desai and others concluded that remote titration of GDMT by navigators using encoded algorithms may represent an efficient, population-level strategy for rapidly closing the gap between guidelines and clinical practice in patients with HFrEF. More details available from the American Heart Association.

Prior Heart Failure Hospitalization, Clinical Outcomes, And Effect Of Sacubitril/Valsartan Compared With Valsartan In Heart Failure With Preserved Ejection Fraction

Muthiah Vaduganathan, MD MPH, presented an analysis of patients from the PARAGON-HF (Prospective Comparison of ARNI with ARB Global Outcomes in HF With Preserved Ejection Fraction) that evaluated the efficacy and safety of sacubitril/valsartan when initiated shortly after hospitalization for heart failure. Dr. Vaduganathan reported amplified relative and absolute benefits of sacubitril/valsartan when started in this high-risk post-discharge window. More details in the Journal of the American College of Cardiology.

Effect Of Intensive Blood Pressure Control On Residual Lifespan In The SPRINT Trial

Muthiah Vaduganathan, MD MPH, and colleagues used data from SPRINT (Systolic Blood Pressure Intervention Trial) to predict survival benefits with intensive vs. standard blood pressure control. They estimate that intensive blood pressure control improves residual survival by 0.5 to 3 years in middle-aged and older adults at high cardiovascular risk but without diabetes. More details available from the American Heart Association.

Contemporary Quality of Life and Outcomes in Patients With Heart Failure With Reduced Ejection Fraction and Comorbid Diabetes Mellitus in the CHAMP-HF Registry

Muthiah Vaduganathan, MD MPH, and colleagues evaluated health-related quality of life (HRQL) data for patients with chronic heart failure with reduced ejection fraction. The team reported that over 40 percent of patients with HFrEF have diabetes, and that these patients had worse HRQL and higher risk-adjusted, 18-month clinical event rates. More details in the Journal of the American College of Cardiology.

Primary, One-year Results of the GOULD Registry of Patients With Atherosclerotic Cardiovascular Disease  

Christopher Cannon, MD, and co-authors assessed lipid-lowering therapy (LLT) for atherosclerotic cardiovascular disease (ASCVD) over time, observing some improvement over the first year with LLT, but noting that further intensive efforts are needed. More details from the American Heart Association.

Do the renal and cardiovascular benefits of SGLT2 inhibitors differ according to baseline HbA1c? Results From the CREDENCE Trial

Christopher Cannon, MD, and colleagues sought to determine if the renal and cardiovascular benefits of SGLT2 inhibitors differed according to baseline HbA1c. The team found that canagliflozin reduced the risk of both kidney failure and CV events in patients with type 2 diabetes and chronic kidney disease irrespective of baseline HbA1c, including in patients with baseline HbA1c <7 percent. More details in Circulation.