Martha Gulati highlights 'exciting' progress in preventive cardiology
The evolving landscape of cardiovascular prevention is being shaped by advancements in managing obesity, a critical risk factor for cardiovascular disease (CVD). At the American Heart Association (AHA) Scientific Sessions 2024 meeting, Cardiovascular Business spoke with Martha Gulati, MD, a leading expert in preventive cardiology, about major trends related to this topic. Gulati is the director of prevention and associate director for the Barbra Streisand Women's Heart Center at Cedars-Sinai and immediate past present of the American Society for Preventive Cardiology.
"One of the major risk factors for cardiovascular disease is obesity. We've known this and it's not rocket science, but the thing is, we haven't had good therapies until recently. And now with the emergence of these new therapies, we're actually able to address this important risk factor in a way that we've never been able to," Gulati explained.
Addressing obesity was a hot topic at the AHA conference, not just to reduce atherosclerotic cardiovascular disease risk in patients but also to reduce the risks of heart failure with preserved ejection fraction (HFpEF) and even atrial fibrillation (AFib). Gulati said research is now helping answer questions around AFib and how different drug therapies should be used.
Gulati added that the new Prevent Risk Score, unveiled in late 2023, is also helping evaluate not only atherosclerotic cardiovascular disease risk, but also the likelihood of developing heart failure, reflecting the expanding scope of cardiovascular risk assessment.
Late-breaking SUMMIT trial offers good news for using tirzepatide in HFpEF
One of the most talked-about late-breaking studies at AHA 2024 was the SUMMIT trial, which tested tirzepatide, an injectable weight-loss medication, in obese patients with HFpEF. The trial showed promising reductions in heart failure events and cardiovascular mortality, setting the stage for potential new treatments for this challenging condition. She said HFpEF in general is an area of unmet need, with no real therapies available. She said this is a disease also disproportionately affects women.
“We are seeing the first real evidence of medications specifically addressing outcomes in HFpEF,” Gulati said. She also pointed to earlier studies involving semaglutide, another injectable therapy, as indicative of progress in managing obesity-related cardiovascular risks.
"This is the first time we have a trial where they saw a reduction in heart failure events as well as cardiovascular mortality. And so now it seems that we actually have a treatment potentially for patients with HFpEF. We had some evidence from another trial on semaglutide, which is also an injectable weight loss medication, but that wasn't the primary endpoint. But now with this evidence, I think it's going to really change things," Gulti explained.
Right now, there are no FDA indications to use these anti-obesity medications for HFpEF, but she had high hopes the SUMMIT trial data will change that soon.
She said another agent to watch in this space are sodium-glucose co-transporter-2 (SGLT-2) inhibitors. These drugs are used to help control blood sugar levels in adults with type 2 diabetes, but may help in this population as well.
Gulati said preventive cardiology is a fun space to watch right now because of the number of new drugs in development and gaining FDA clearance.
"There are there's so many medications right now, especially in the preventive area, so it's exciting. But it's hard to keep up with all of them. There are so many emerging therapies, and I think our technology of tackling disease is changing, meaning we can now modify proteins and modify RNA and change the disease process in its tracks," she explained.
There are several new medications emerging for lipid management and blood pressure control. She said some of these new hypertension medications are going to be injectable.
Barriers and equity in preventive cardiology care
Despite the excitement surrounding these therapies, Gulati highlighted concerns about the high cost and accessibility of some of the newer drugs. Injectable medications especially, while very effective, are often expensive, raising concerns about healthcare inequity.
“We don’t want to create greater inequity in care, meaning that some people can get these therapies that other people can't. And it's usually the same people with the highest burden of disease that are the people with the worse social determinants of health. We're going to leave people behind if we don't figure out how to reduce the cost," Gulati said.
She called for solutions to lower costs and ensure these treatments reach underserved populations, noting that oral medications may offer a more cost-effective alternative.
Future directions in preventive hypertension care
Looking ahead, Gulati expressed optimism about emerging therapies across multiple areas of cardiovascular prevention, including lipid and blood pressure management. She also pointed to upcoming guideline updates, such as the anticipated 2025 hypertension guidelines, which will address innovations like renal denervation for treatment-resistant hypertension.
Dave Fornell has covered healthcare for more than 17 years, with a focus in cardiology and radiology. Fornell is a 5-time winner of a Jesse H. Neal Award, the most prestigious editorial honors in the field of specialized journalism. The wins included best technical content, best use of social media and best COVID-19 coverage. Fornell was also a three-time Neal finalist for best range of work by a single author. He produces more than 100 editorial videos each year, most of them interviews with key opinion leaders in medicine. He also writes technical articles, covers key trends, conducts video hospital site visits, and is very involved with social media. E-mail: dfornell@innovatehealthcare.com