Crucial practice changing science is coming to Atlanta in April 2024!
Filed by Dr. Jim Rybacki on February 5, 2024
It’s American Heart Month and did you know that the American College of Cardiology is meeting in Atlanta April 5-8th this year? It’s true, and I will be on site with a film crew to bring you the latest info from some of the best cardiologists and researchers on the planet! The remarkable thing is that we already know the names of the Late Breaking Scientific sessions AND that there will be three featured clinical research sessions AND two deep dive sessions to provide expert study insights. This year, I have the very early schedule of what will be major news!
I fly out to Atlanta on Friday April 5th and I expect to be blogging live from the meeting AND getting the chance to interview the women and men who actually did the research as well as a thought leader or two. Let’s take a closer look—My colleagues at GRP studios are in discussions with the American College of Cardiology (ACC) and are getting their cameras tagged and important permissions for interviews AND I believe that they have also proposed me as a safety valve interviewer if the need arises.
All of the studies in the Late Breaker sessions are available from the ACC here.
What I want to focus on are the studies for: After a Heart Attack (Acute MI), for patients at elevated or major risk of CV events and for those with Heart Failure (HF). Some of this is very complicated, but let me organize the medicine generic names and the study names in particular. I expect that there will be major news pick ups of the studies, but you never know. Since I’m a heart patient myself, I bring a unique perspective because I’ve been to the cath lab.
Late Breaking studies involving patients after a heart attack
The EMPACT-MI trial will no doubt show how empagliflozin (you may know it as Jardiance) may or may not impact patient outcomes AFTER a heart attack.
AEGIS-II has been evaluating the effect of unique apolipoprotein A-I infusions after a heart attack
The REDUCE-AMI study is assessing the long-term effects of beta blocker treatment in the specific patient population of preserved left ventricular ejection fraction and
The TACT2 study used edetate disodium infusions after heart attacks in patients living with diabetes.
Late Breaking studies for people at risk of CV events and
Risk, risk, risk. If your loved ones had significant risk, would you want to lower that risk? Of course, you would.
The BE ACTIVE study randomized a group of people at high risk for major adverse Cardiovascular (CV) events into financial incentives, gamification or both as tools to increase physical activity. We will find out in Atlanta what worked and why!
BRIDGE CS8-TIMI 73a is a study that used a novel medicine called olezarsen (from Ionis pharmaceuticals) to try to help people with high triglycerides and increased CV risk. This medicine is an experimental ligand-conjugated antisense drug which just may show significant results!
LIB003 is being studied for long term use in people with high CV risk who are also on stable lipid-lowering treatment! The Atlanta release will tell us about potential side effects, benefits and outcomes!
Late Breaking Clinical Trials for patients with Heart Failure
Heart failure (HF) is a pervasive problem in the US and around the world. Those living with HF face daily limitations and help is urgently needed.
The RELIEVE-HF study looked at the benefits of an inter-arterial shunt in people with HF and both reduced AND preserved ejection fraction (a measure of fluid ejected—in this case, blood ejected from a chamber such as the heart and the left ventricle with each contraction of the heart muscle).
Arise -HF (AT-001) looked at the benefits of a selective aldose reductase inhibitor seeking to help diabetic cardiomyopathy. We will find out in Atlanta if this experimental drug helps improve the heart’s ability to pump blood and prevent worsening of the disease.
AS USUAL, there will be additional interviews, surprise breakthroughs and I will adjust my schedule to cover what I think are the best and more game-changing results!
Dr. Rybacki attends the American Heart Association meeting 11/10/23
Filed by Dr. Jim Rybacki November 12, 2023
I flew out to The American Heart Association (AHA) Nov 10-13 in Phile. As always, there were be Late breaking science sessions that I detailed below. —This year—news broke early too: Tirzepatide (Mounjaro for diabetes) is now ALSO Zepbound for weight management! WOW.
More details on the Cardiology page as they emerge and I do plan an updated Essential Guide to Prescription Drugs, Mounjaro and Zepbound publication that you can preorder now.
I promise some new video footage in the Spring 2024 as I expect to find a wealth of breaking news at ACC in April and will bring a film crew with me as I attend. I’ve already lined up some thought leaders in Cardiology and Heart Success (Congestive Heart Failure Clinic Specialists) and will have some new colleagues to interview on camera. More to follow as always…
Dateline November 11, Saturday morning from Philadelphia: Filed by Dr. Rybacki:
The huge auditorium was filled to capacity for the opening #AHA23 session presided over by Dr. Joseph Wu, the Director of the Stanford Cardiovascular Institute. There were many awards given out (more to follow later) and Dr. Wu also led the Obesity-Novel therapeutics and Implications session. I was lucky to catch up with him after the LBS .01 Session and complemented him on a real-world analogy he made regarding the obesity and CVD burden and the effect on our bodies.
Wu said, it’s like putting a 2,000 pound boulder in the back of a pick up truck. This will put huge stress on the transmission, the engine, the tires and almost every component of the truck. Taking one step like changing a tire will NOT make a significant difference—you have to chip away and eventually remove the boulder!
LBS.01 from the American Heart Association Scientific sessions: An important late breaking session was presented entitled Obesity- Novel Therapeutics and Implications for Population Health. There were several presentations within this title. I thought the largest breaking news was already out on November when the FDA APPROVED tirzepatide (still Monjaro for type 2 diabetes) and NOW to be also known as ZEPBOUND injection for ongoing (chronic) weight management in adults with specific characteristics: Patients will need to have a diagnosis of obesity (body mass index-BMI of 30 kg per square meter or more, or overweight (BMI of 27 kg/ square meter or more) with at least one weight-related condition. Those conditions include high blood pressure, type 2 diabetes or high cholesterol. Zepbound should be used in addition to a lowered calorie diet AND increased physical activity. Dr. Rybacki will be updating the current Essential Guide to Prescription Drugs on Mounjaro and it will be available in 3 weeks. CLICK HERE to pre-order the PDF!
One of the STARs of the obesity session turned out to be from the SELECT trial. Dr. Lincoff from the Cleveland Clinic talked about the results and the amazing, practice changing and validating results in 17,604 adults studied for 40 months was that semaglutide (Wegovy) reduced secondary cardiovascular risk by 20% in people who were overweight or obese who had pre-existing heart disease without diabetes.
It’s highly unusual to hear applause or cheers during these meetings, but in the SELECT case for Wegovy (semaglutide) there were both. Nicely done Dr. Lincoff and colleagues. The benefits for patients and their families will be fantastic!
What’s next? Future research will probably try to show that other medicines in the same family also confer such amazing benefits.
LBS.02. Hot Topics in Management of Coronary Artery Disease/Acute Coronary Syndrome rounded out the morning of breaking science. Dr. Rybacki attended the presentations and thought that 2 of the studies were especially interesting:
ORBITA-2
ORBITA-2 was presented by Christopher Rajkumar and took a close look at PCI compared to placebo to see how it improved the angina symptom score at 12 weeks. The study found that PCI helped symptomatic angina in people with ongoing (chronic) heart coronary) disease and is safe. As always, there was a well-qualified person (discussant) to talk about the results.
Connie Hess, MD noted that 11 million Americans have stable angina and reviewed the results. She thought that angina relief in these symptomatic patients aligns with current science of the biology and pathophysiology of angina.
What’s next? Dr, Hess thought that Future research might include studies of the cost-effectiveness of PCI as antianginal monotherapy, review of longer-term outcomes and a better understanding of residual symptoms. She advocated an ORBITA 3 trial!
Saturday Afternoon, November 11, 2023 Main Event 1: Filed by Dr. Rybacki with a focus on POCKET-COST-HF, Cost integration and shared clinician-patient decision making in Heart Failure and sustained blood pressure lowering in KARDIA-1 with a new drug
LBS.03. Heart Failure-VADS, KIDS, and Money:
LBS.04.Using Drugs, Diet and Delivery to Optimize Hypertension Outcomes:
The TEAMMATE trial tried to understand the use of a drug called everolimus to prevent rejection of organ in children after heart transplants. The current standard of care is a combination of two drugs-tacrolimus and mycofenolate mofetil (MMF), but the median survival is only 18 years. This means that many children fail to survive to adulthood because of transplant complications. Everolimus works in a novel way to reduce the risk of rejection, yet the FDA issued a block box warning against use in heart transplant because of higher risk of death because of infection. This study waited until 6 months after transplant to actually start everolimus and use it in combination with low-dose tacrolimus. The study found that at 30 months, the burden of allograft vasculopathy, chronic kidney disease and cellular rejection was NOT different in the experimental group compared to the MMF group. The study group had better kidney function, lower anti-HLA antibody development and less CMV Virus infections. The downside was an increase in abnormal lipids and higher liver enzymes.
What’s next? Future research—an extended study of TEAMMATE, following the children into the future makes sense. More to follow at future conferences and as new studies start.
POCKET-COST-HF looked at the effect of telling patients about out-of-pocket costs of heart failure medicines in a shared decision making model. This is a very interesting approach as it makes everyone aware of the potential expense. Patients were much more likely to take their meds and did this 92 percent of the time in the cost-aware group!
What’s next? Future research-I could be so simple to put costs into the hospital information system (Epic, Cerner, Meditech, etc.) and print this out for the patient and family before discharge so that they would be aware of any increased expenses. Because many hospitals also have a meds-to-beds program, this would avoid surprises. Future research could also include non-English speaking patients and provide an in-patient to outpatient attending pharmacist model so that the information provided in the hospital could also be reinforced at the Pharmacy visits in the same way!
New medicines have unusual names and a novel high blood pressure drug called zilebesiran was studied in Kardia-1. I know wat you are thinking, so it treats high blood pressure…there are lots of medicines for that. What if I told you that you could get strong control of blood pressure by taking Zilbe only once every 24 weeks ? Dr. George Bekris presented the data on this novel anti-hypertensive that works on liver (hepatic) AGT synthesis. People in the study had mild to moderate high blood pressure. The results showed that SIGNIFICANT lowering of systolic Blood Pressure (the top number of a BP) at month three were maintained through month 6. The investigators concluded that after further studies are done, perhaps every 3 or every 6 month dosing could be used. People often do NOT like to keep on taking pills daily.
What’s next? Future research in concert with FDA thoughts of this small interfering (siRNA) RNA therapeutic will decide the best dose and how often the best dose needs to be given!
Diet and sodium and fat often come into play in blood pressure studies.
Sunday Morning-Main event 1
LBS.05 Shocking Decisions in AFib Care
Sunday Afternoon Main Event1
LBS.06. Future of Lipid lowering therapy-Novel mechanisms and approaches
Monday Morning Main Event 1
LBS.07. From Local to Global: Achieving Equity in Prevention
Monday Morning Main event 1
LBS.08 Artificial Intelligence at the Bedside.
Check in daily as this section will be updated often over the next week!
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