American Heart Association Scientific Sessions to feature Brigham breakthroughs

November 13, 2020

* LDL Cholesterol Lowering Drugs Benefit Older and Younger Patients Equally: Older individuals face an increased incidence of cardiovascular events compared to younger individuals. Paradoxically, however, proven lipid-lowering therapies remain underused in older patients because these individuals have typically comprised small subsets of clinical trials and thus there has been a less persuasive evidence base. A new systematic review and meta-analysis of 29 trials which included 244,090 patients including 21,492 patients aged 75 years or older found that lipid-lowering therapies reduced the risk of major cardiovascular events in older patients just as much as they did in younger patients, with a 26 percent reduction in major cardiovascular events per 1 mmol/L reduction of LDL cholesterol (LDL-C). The benefit of LDL-C lowering in the elderly was consistent for cardiovascular death, myocardial infarction, stroke, and coronary revascularization and consistent, per 1 mmol/L reduction in LDL-C, for statin and non-statin lipid-lowering therapies (ezetimibe and the PCSK9 inhibitors, evolocumab and alirocumab).

"Our analysis indicates that these therapies, which are affordable drugs that have reduced risk of heart disease for millions of people worldwide, are as effective in reducing cardiovascular events and deaths in older people as they are in younger people," said corresponding author Marc Sabatine, MD, MPH, of the Division of Cardiovascular Medicine at the Brigham. "We found no offsetting safety concerns and, together, these results should strengthen guideline recommendations for the use of cholesterol-lowering medications, including statin and non-statin therapy, in elderly people."

The study will be presented Nov. 13 at 10 a.m. EST and published simultaneously in The Lancet.

* Over 80 Percent of Heart Failure Patients Eligible for Treatment with Recently FDA-Approved Therapy: In May 2020, the U.S. Food and Drug Administration (FDA) approved dapagliflozin, a blood sugar-lowering drug, as a therapy for patients with heart failure with reduced ejection fraction (HFrEF). While the drug, a type of SGLT2 inhibitor, was originally developed to treat type 2 diabetes, there is increasing evidence that SGLT2 inhibitors reduce risks of cardiovascular events in patients with and without diabetes. To determine what proportion of HFrEF patients might be candidates for dapagliflozin treatment according to the new FDA labeling, Brigham researchers and collaborators analyzed data from 154,714 patients hospitalized with HFrEF at over 400 hospital centers across the U.S. participating in the American Heart Association's Get With The Guidelines-Heart Failure registry. They found that 81.1 percent of participants would be eligible for dapagliflozin, with the most common explanation for non-candidacy being advanced kidney disease. HFrEF patients with type 2 diabetes had a lower proportion of eligibility (75.6 percent) compared to those without type 2 diabetes, of whom 85.5 percent were eligible.

"Despite accelerating scientific discoveries, few patients with heart failure are being treated with the best available treatment options in 2020," said lead author Muthiah Vaduganathan, MD, MPH, of the Division of Cardiovascular Medicine at the Brigham. "While SGLT2 inhibitors were first developed for treatment of diabetes, these therapies have now been recognized to reduce mortality, prevent worsening heart failure events, and improve health-related quality of life in patients with HFrEF, including those without diabetes. Our data suggest that effective implementation of SGLT2 inhibitors is poised to impact a large at-risk population across a broad range of US health systems."

The study will be presented Nov. 13 at 10 a.m. EST and published simultaneously in JAMA Cardiology. This work is the first of a series of studies under a new collaboration called TRANSLATE-HF led by Vaduganathan and investigators at 10 different institutions nationwide that is being launched by the American Heart Association and AstraZeneca to better understand how new therapies for heart failure can best be implemented in clinical practice to improve patient outcomes.

* Cardiothoracic Organ Transplantations Increase Among Non-U.S. Citizens, With No Evidence of Worse Outcomes: In the past decade, cardiothoracic organ transplants have increased in the United States for both citizens and non-citizens, with non-U.S. citizens now representing between 3 and 4 percent of heart- and lung-transplant recipients. However, federal funding for transplant and post-transplant care for non-US citizens is restricted and varies by residency status. While citizenship-based disparities in liver and kidney transplant outcomes were not identified in recent studies, similar investigations into cardiothoracic transplant outcomes have not been pursued. Brigham researchers and collaborators studied 31,033 transplant recipients from 2013-2018 from the United Network for Organ Sharing and found that non-U.S. citizens who received heart and lung transplants experienced similar rates of risk-adjusted graft failure and mortality compared to U.S. citizens.

"Our study shows that non-U.S. citizens and U.S. citizens have similar outcomes at one year after heart or lung transplant," said co-first author Lauren Sinnenberg, MD, of the Division of Cardiovascular Medicine at the Brigham. "It remains unknown whether there exist disparities in access to transplantation for non-U.S. citizens. This will be an important focus of future work."

According to the study, more non-U.S. citizens are now receiving cardiothoracic transplants than ever before. The absolute proportion of transplantations is growing steadily by 0.3 percent annually according to the researchers' data. Non-U.S. citizens in the study were more likely to be Hispanic (comprising 40 percent of recipients, versus 8 percent of U.S. recipients) and more likely to be supported by Medicaid (22 percent vs. 13 percent). U.S. citizens receiving transplants were more likely to be white (70 percent vs. 37 percent) and more likely to be supported by private insurance (46 percent vs. 35 percent).

The study will be presented Nov. 13 at 10 a.m. EST and paper will be published simultaneously in Circulation: Heart Failure.
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Brigham and Women's Hospital

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