AHA's 2021 Cardiovascular Medicine Progress "All-in-One" Drug Re-recommended

Recently, the American Heart Association (AHA) announced important medical research progress in the field of heart disease and stroke in 2021

Findings from these studies have led to better treatments for stroke, heart failure and hypertension, addressing cardiovascular-related diseases such as renal failure and obesity, the AHA noted, and cutting-edge developments in precision gene editing are driving improvements in fatal Treatment of heart disease

Addressing hypertension: both life>

High blood pressure is one of the main causes of myocardial infarction and stroke

The New England Journal of Medicine (NEJM) published the Salt Substitute and Stroke Study (SSaSS) in more than 20,000 Chinese people led by a team from Peking University.

Another NEJM paper, also from a Chinese team, provides a reference for the target blood pressure for the treatment of elderly hypertensive patients

Prevention of myocardial infarction and stroke, antihypertensive and lipid-lowering "all-in-one" drugs are supported again

For people at high risk of cardiovascular disease, many patients need to pay attention to multiple indicators such as blood pressure and blood lipids at the same time

The results of the TIPS-3 study based on the compound drug concept were published in NEJM

The sooner the stroke treatment, the better

For stroke (stroke) treatment, time is the brain

NEJM published a multicenter study in the United States that compared emergency medical services with standard management of a mobile stroke unit (rescue with specially trained personnel, CT scanners, and laboratory testing equipment) within 4.

A Spanish study published in JAMA Neurology found that by bypassing emergency rooms and traditional imaging tests, stroke patients underwent angiographic imaging directly in the hospital to quickly restore blood flow to the brain, helping to restore blood flow to the brain.

Precision gene editing leads to new options for treating deadly heart disease

Using precise gene editing, researchers have opened the door to new treatments for two life-threatening diseases - transthyretin amyloidosis (ATTR) and Duchenne muscular dystrophy (DMD)

In June of this year, NEJM published the results of the first clinical trial of in vivo CRISPR gene editing

DMD causes skeletal and cardiac muscle degeneration, and gene editing based on CRISPR/Cas9 technology has the potential to improve cardiomyopathy in DMD

Additional anticoagulant therapy requires careful evaluation

Two important studies have explored the appropriate dose and timing of antiplatelet drugs

The MASTER DAPT trial, published in NEJM, found that for patients at high risk of bleeding after implantation of drug-eluting coronary stents, reducing dual antiplatelet therapy from 2 months to 1 month helped reduce bleeding risk without increasing cardiac risk.

Research published in JAMA Internal Medicine found that nearly one-third of patients receiving direct oral anticoagulation (DOAC) for atrial fibrillation or venous thrombosis, who were also taking aspirin, had higher bleeding and associated risk of hospitalization, while coagulation rates did not improve

The "old and difficult" obesity problem ushered in effective drugs

About 650 million people worldwide suffer from obesity, which is a major risk factor for cardiovascular disease
.

In June 2021, the once-weekly subcutaneous injection of semaglutide (2.
4 mg) became the first new drug approved by the U.
S.
FDA since 2014 for the control of general obesity or overweight
.
Specifically, the drug is approved for long-term weight control in adults who are obese or overweight and have at least one weight-related symptom, in combination with reduced calorie intake and increased exercise
.

A series of pivotal clinical trials of semaglutide have been featured in top medical journals demonstrating its potential weight loss benefits:

STEP-1 Study: Published in NEJM
.
Patients with a BMI ≥30 and without diabetes lost an average of 14.
9% of their body weight after 68 weeks of semaglutide treatment
.

STEP-2 Study: Published in The Lancet
.
Semaglutide was effective in overweight adults with type 2 diabetes, with an average weight loss of 9.
6% after 68 weeks
.

STEP-3 Study: Published in JAMA
.
Semaglutide combined with intensive behavioral therapy helped overweight or obese adults lose an average of 16% of their body weight
.

STEP-4 Study: Published in JAMA, in overweight and obese non-diabetic adults, adherence to semaglutide for 68 weeks was associated with sustained weight loss compared to 20 weeks of treatment
.

In addition, the benefits of bariatric surgery have received a lot of attention in recent years
.
A large study of approximately 2,600 patients, published in the AHA journal Circulation, showed that among patients with cardiovascular disease and severe obesity, those who underwent bariatric surgery were more likely to die or die after bariatric surgery than their peers who had not undergone bariatric surgery and were in similar health.
A 42% lower risk of major cardiovascular disease such as heart attack, stroke and heart failure hospitalization
.

SGLT2 inhibitors continue to "show their skills" in addition to hypoglycemic

Two studies of SGLT1/2 dual inhibitor sotagliflozin in diabetic patients won the NEJM
.

SCORED Trial: The first trial to show a benefit of an SGLT2 inhibitor in patients with varying degrees of proteinuria, and the first to show a benefit of an SGLT2 inhibitor for stroke prevention
.
In patients with type 2 diabetes and CKD and cardiovascular risk, sotagliflozin significantly reduced the combined risk of death from cardiovascular causes, hospitalization for heart failure, or emergency department visits for heart failure by 26%, with all myocardial infarction or stroke risks, respectively 32% and 34% lower
.

SOLOIST-WHF Trial: The first large randomized trial to demonstrate the safety and efficacy of initiating SGLT2 inhibitor therapy in hospitalized patients with acute heart failure
.
Among patients hospitalized with type 2 diabetes and a recent exacerbation of heart failure, the sotagliflozin group had a significant 33% reduction in the risk of death from cardiovascular causes, as well as readmissions and emergency room visits for heart failure
.

Heart failure with preserved ejection fraction (HFpEF) is the most common type of heart failure in older adults
.
The large clinical trial EMPEROR-Preserved, published in the NEJM, identified for the first time a drug with a significantly positive effect on the prognosis of HFpEF
.
In adults with HFpEF, empagliflozin reduced the relative risk of cardiovascular death or hospitalization for heart failure by 21% compared with placebo
.
People with diabetes or not can benefit from it
.

Prevention of cardiovascular complications of diabetes

People with type 2 diabetes at least double their risk of cardiovascular disease (both morbidity and mortality), and kidney disease is a common long-term complication
.
Two new studies bring new hope for the treatment of these complications
.

FIGARO-DKD Trial: In patients with type 2 diabetes and chronic kidney disease, finerenone reduced the risk of the composite endpoint of cardiovascular events by 13% compared with placebo, with the main improvement being a reduction in hospitalizations for heart failure
.

AMPLITUDE-O Trial: In patients with type 2 diabetes with a history of cardiovascular disease or a current history of kidney disease and at least one other cardiovascular risk, efpeglenatide will result in myocardial infarction, stroke, or death from cardiovascular/unexplained causes Combined risk reduction of 27%
.

Flu vaccine may help protect heart health

Influenza vaccine is now generally recommended for people with cardiovascular disease, and the flu vaccine also provides protection longer after the flu season
.
A randomized, double-blind trial published in Circulation found that patients who received the flu vaccine within 72 hours of MI or invasive coronary surgery were at risk for MI, stent thrombosis, or death from any cause in the following year A 28% reduction, and a 41% reduction in the risk of dying from cardiovascular disease
.

The unique impact of Covid-19 on children's hearts

After contracting Covid-19, children may develop multisystem inflammatory syndrome (MIS-C), which causes dangerous inflammation of the heart, lungs, kidneys, brain, skin, eyes and other organs, according to a European study published in Circulation
.
Common cardiac effects of this new syndrome include cardiac arrhythmias, shock, coronary dilation, and fluid accumulation in the pericardial sac surrounding the heart
.

Two other studies, published in NEJM, both showed that the risk of myocarditis following mRNA Covid-19 vaccine was low, with most cases being mild or moderate and resolved
.

The AHA currently recommends vaccinating adults and eligible children against Covid-19, noting that existing research clearly shows that the risk of heart complications, stroke and blood clotting problems is much higher with Covid-19 than with vaccination
.

Heart Health During Pregnancy Affects Risks for Mother and Baby

An analysis of data on all live births in the United States from 2011 to 2019 suggests that most women had poor cardiovascular health before pregnancy, and this trend is worsening: the proportion of women with an ideal cardiovascular score before pregnancy fell from 42.
1% in 2011 to 37.
7% in 2019
.

A study published in JAMA shows that a mother's heart health during pregnancy can have a major impact on a child's cardiovascular health during early adolescence (ages 10-14)
.

References

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