On November 10, 2018, the American Heart Association (AHA) held its annual Scientific Sessions meeting, 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.
REDUCE-IT Reveals High Dose of Pure EPA in Omega-3 Drug Cuts Risk of Cardiovascular Events
Clinical trial of icosapent ethyl finds 25 percent reduction in cardiovascular events among at-risk patients.
Deepak L. Bhatt, MD, MPH, Executive Director of Interventional Cardiovascular Program in the Heart & Vascular Center, presented results from the REDUCE-IT clinical trial, which tested whether icosapent ethyl, a highly purified form of a fish oil, could reduce the risk of cardiovascular events in at-risk patients who either had atherosclerosis, or diabetes plus at least one other cardiovascular risk factor along with elevated triglyceride levels, despite taking statins.
The REDUCE-IT trial showed that participants who took icosapent ethyl saw a 25 percent risk reduction in cardiovascular events and a 20 percent reduction in death due to cardiovascular causes, a result Dr. Bhatt described as “remarkable.”
“This may be the biggest development in cardiovascular secondary prevention since statins. The REDUCE-IT trial sets a new standard of care for these patients,” said Dr. Bhatt.
See the press release for more information about the REDUCE-IT clinical trial.
VITAL Study Reveals How Vitamin D and Fish Oil Supplements Affect Risk of Heart Attack, Stroke and Cancer
Findings show omega-3 fatty acids reduced risk of heart attacks, especially among African Americans; vitamin D reduced cancer deaths over time.
JoAnn Manson, MD, DrPH, Chief of the Division of Preventive Medicine, presented results from the VITamin D and OmegA-3 TriaL (VITAL). The VITAL study examined whether omega-3 fatty acids affected a person’s risk of experiencing cardiovascular events and cancer occurrence
The study population was racially and ethnically diverse. Twenty percent of the participants were African American, a racial and ethnic group that has not been well studied in previous trials of omega-3 supplements.
The VITAL trial 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.
See press release for more information about the VITAL Study.
Diabetes Drug Lowers Heart Failure Risk
DECLARE–TIMI 58 trial shows SGLT-2 inhibition can prevent hospitalization for heart failure, reduce likelihood of renal disease progression in patients with or without established heart disease.
Stephen Wiviott, MD, of Cardiovascular Medicine, shared findings from the DECLARE–TIMI 58 trial, a multinational trial that tested the SGLT-2 inhibitor, 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 SGLT-2 inhibitor reduced the risk of hospitalization for heart failure in routine care.
See press release for more information about DECLARE–TIMI 58 trial.
Low-Dose Methotrexate Does Not Reduce Risk of Cardiovascular Events
Methotrexate neither inhibited critical inflammatory pathways nor reduced rates of heart attack, stroke and cardiovascular death.
Paul Ridker, MD, Director of the Center for Cardiovascular Disease Prevention, delivered results from the Cardiovascular Inflammation Reduction Trial (CIRT) that tested whether low-dose methotrexate 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 Dr. 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-1b 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.
See press release for more information about the CIRT trial.