New hypertrophic cardiomyopathy guidelines highlight importance of exercise, new drug class
Cardiologists managing the care of patients with hypertrophic cardiomyopathy (HCM) should encourage them to exercise and consider the use of cardiac myosin inhibitors, according to new guidelines developed by the American College of Cardiology (ACC) and American Heart Association (AHA). The recommendations were published in full in both the Journal of the American College of Cardiology and Circulation.[1,2]
HCM is a potentially fatal cardiac condition caused by a gene mutation that makes the heart muscle too thick. As many as one in 500 patients show signs of HCM, but it often goes undiagnosed. Symptoms include chest pain, fainting, shortness of breathe and irregular heartbeats.
The ACC and AHA collaborated on these new guidelines to provide care teams with the most up-to-date look possible at this serious condition.
“Incorporating the most recent data, this new guideline equips clinicians with the latest recommendations for the treatment of HCM,” Steve R. Ommen, MD, medical director of the Mayo Hypertrophic Cardiomyopathy Clinic and chair of the guideline’s writing committee, said in a statement. “We’re seeing more evidence that patients with HCM can return to their normal daily lives with proper care and management.”
Benefits of exercise for HCM patients appear to outweigh any risks
Prior studies have found that competitive athletes with HCM may increase their risk of sudden cardiac death (SCD). However, the writing committee emphasized that “a disproportionate risk of SCD has not been demonstrated in athletes in contemporary registries.” The group did note that any HCM patients who perform in competitive sports should undergo annual evaluations to be safe.
When it comes to patients who are not competitive athletes, the impact of exercise is a little more straightforward: its benefits outweigh any potential risks.
“Recommendations for physical activity continue to evolve with research,” Ommen said. “As part of a healthy lifestyle, patients with HCM are now encouraged to engage in low-to-moderate intensity physical activities. We’re seeing how vigorous physical activities can be reasonable for some individuals. With shared decision-making between the clinician and the patient, some patients may even be able to return to competitive sports.”
Cardiac myosin inhibitors offer value—but clinicians need proper training to prescribe them
Cardiac myosin inhibitors are a new class of medication that can benefit patients presenting with HCM who do not benefit from first-line drug therapy. Specialists do need to undergo special training in order to prescribe them to patients.
Mavacamten, sold by Bristol Myers Squibb under the name Camzyos, is currently the only cardiac myosin inhibitor approved by the U.S. Food and Drug Administration. It was approved by the agency in May 2022 for symptomatic obstructive HCM, though it is not recommended for pregnant patients.
“These new drugs offer an alternative for patients who have failed first-line therapy and either want to delay or possibly avoid more aggressive options,” Ommen said.
Additional details about these new recommendations
The writing committee behind this new document included clinicians, adult cardiologists, pediatric cardiologists, interventional cardiologists, a cardiac surgeon and two patient representatives. They will now monitor new data related to the management of HCM as it becomes available.
The American Medical Society for Sports Medicine, Heart Rhythm Society, Pediatric and Congenital Electrophysiology Society and Society for Cardiovascular Magnetic Resonance all worked with the ACC and AHA to develop these recommendations.
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.