New drugs, updated treatment strategies: 5 important trends in cardiology from an eventful 2023
With the end of the year rapidly approaching, the American Heart Association (AHA) editorial staff has published a list of some of 2023’s biggest breakthroughs in cardiovascular disease (CVD) research.
“In 2023, investigators made important strides toward improving and extending the lives of people affected by these conditions, along with potentially lowering the burden of disease with therapies and strategies that hold promise for prevention,” the AHA editors wrote. “Particularly noteworthy were advances in technology to restore blood flow to blocked and narrowed arteries, potentially preventing death and disability for a wide range of patients, including those with severe illness.”
The AHA’s choices included:
1. Zilebesiran shows potential for preventing hypertension
A new investigational drug, zilebesiran, can decrease the production of angiotensinogen, a protein believed to contribute to a patient's risk of high blood pressure. Early data suggests taking zilebesiran for eight weeks is associated with reductions in key blood pressure measurements compared to a placebo; higher doses are linked to higher reductions.
“Not only does the suppression of angiotensinogen hold promise for more effectively reducing hypertension for extended periods of time after injection, there is growing excitement over the possibility it also might be therapeutic for kidney and heart disease,” AHA’s editors wrote. “The results are also highly significant because only a single dose was needed, which could improve access to care and adherence to long-term drug regimens.”
The full analysis was published in The New England Journal of Medicine.[1]
2. Intravascular imaging-guided PCI linked to key benefits
The concept of using intravascular imaging to guide percutaneous coronary intervention (PCI) procedures gained significant momentum in 2023. (Cardiovascular Business wrote about this topic several times, including here, here and here.)
AHA’s editors highlighted multiple studies that examined the potential impact of intravascular imaging. The ILUMIEN IV study, for example, found that PCI guided by optical coherence tomography (OCT) resulted in a larger minimum stent area than angiography-guided PCI. That analysis was published in full in The New England Journal of Medicine.[2]
The OCTIVUS trial, published in Circulation, showed that OCT-guided PCI and intravascular ultrasound were both safe and effective treatment options for patients with significant coronary artery lesions.[3]
3. A new perspective on prescribing anticoagulants to stroke patients with AFib
Treating atrial fibrillation (AFib) patients with direct-acting oral anticoagulants (DOACs) after a stroke can reduce their risk of experiencing another stroke—but the exact timing of prescribing those DOACs remains unclear.
“Doing so too early could increase the risk of brain bleeds, while doing so later could raise the risk of having a second stroke,” AHA’s editors wrote.
Physicians typically recommend stroke patients wait a few days before they start taking DOACs, but new research published in The New England Journal of Medicine provided evidence that those patients could start treatment even sooner.[4]
Overall, the study found that starting DOAC treatment within 48 hours of a stroke was associated with outcomes comparable to starting treatment on day three or four after a stroke—one key difference was that the risk of recurrent stroke appeared to decrease with early treatment.
“The trial was not designed to test whether earlier treatment was better than later treatment, but to help health care providers estimate possible outcomes,” the editors wrote.
4. Healthy eating habits linked to a lower overall risk of mortality
The AHA has regularly emphasized the importance of following a heart-healthy diet over the years, so it was no surprise to see its editors highlight this subject.
Recent research published in JAMA Internal Medicine found a clear relationship between following a healthy eating pattern and facing a lower risk of all-cause mortality.[5] The study included more than 75,000 patients from the Nurses’ Health Study and more than 44,000 men from the Health Professionals Follow-Up Study.
“These findings from such a large cohort provide further support for the American Heart Association’s Food is Medicine initiative … can help prevent, manage and treat chronic illness,” the editors wrote.
5. Diabetes drugs may improve the heart health of patients without diabetes
Perhaps the biggest story in cardiology for the entire year was the potential of GLP-1 agonists such as semaglutide to help patients reduce their risk of cardiovascular disease (CVD). The editors of Science even named it their 2023 Breakthrough of the Year.
As AHA’s editors explained, “a growing body of research” suggests that these drugs—which were originally developed to fight diabetes—could also help protect patients from heart failure and other significant cardiac issues. The group focused on two studies featured in The New England Journal of Medicine—one analysis found that these drugs could benefit heart failure patients and the second analysis found that they could potentially help obese and overweight patients with no prior history of CVD.[6, 7]
“While these developments are certainly promising, an editorial in The New England Journal of Medicine warns the high cost of these medications may make them inaccessible to many who need them and should not deter public health efforts to fight the root causes of the nation’s obesity epidemic,” the editors wrote.
Those represent just some of the AHA’s selections. Click here to read the full breakdown.
Michael has more than 18 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.