Top General Cardiology and Prevention News of 2022
The FDA’s fight against Big Tobacco, the return of obicetrapib, and the promise of Lp(a)-lowering all made waves in 2022.
One of the year’s bigger stories in the ongoing battle to prevent cardiovascular disease was the US Food and Drug Administration’s clampdown on the tobacco industry. Earlier this year, the agency announced plans to ban menthol (29 Down) cigarettes, along with flavored cigars, because menthol makes smoking more palatable and eases the harshness of nicotine.
In both primary and secondary prevention, several new drugs to treat elevated lipid levels also made a splash. In OCEAN(a)-DOSE (oceanadose, 41 Across), the TIMI researchers showed that olpasiran safely lowered lipoprotein(a) concentrations by as much as 100%. Inclisiran (45 Down), an LDL-lowering drug approved in 2021, moved into clinical practice, but one of the year’s earliest stories suggested it might encounter hurdles as doctors grappled with its rollout and steep price tag. Both olpasiran and inclisiran are small-interfering RNA molecules that belong to the next-generation of injectables able to alter the expression of specific genes (siRNA, 33 Across).
Everybody loves a good comeback, it seems, as one of the more popular stories of 2022 revolved around obicetrapib (61 Across), which is part of a drug class abandoned after the HDL hypothesis fell out of favor. The ROSE study showed obicetrapib could safely lower LDL-cholesterol levels when used as an add-on therapy, and the drug is now being tested in a larger phase III trial.
Four years after the fact, people are still debating the results of the REDUCE-IT trial of icosapent ethyl, with still more discussion of whether the placebo (mineraloil, 39 Down) was truly inert in this trial. In obesity news, tirzepatide (20 Across) was effective at helping patients with elevated body mass index (BMI, 53 Across) lose 22 lbs in the SURMOUNT-1 trial. For women, the CHAP (13 Down) trial showed that keeping blood pressure to less than 140/90 mm Hg translates to better pregnancy-related outcomes when compared with only treating those with severe hypertension.
Another popular primary-prevention story stemmed from the United States Preventive Services Task Force finally joining a range of other authorities in concluding that aspirin (ASA, 4 Down) should not be broadly used in older individuals without heart disease.
Lastly, one of the more popular stories of the year related to the American Heart Association (AHA) emphasizing the importance of sleep. Where the AHA once asked people to adhere to “Life’s Simple 7,” a composite that assesses dietary quality, physical activity, exposure to cigarette smoking, body mass index, fasting blood glucose, total cholesterol, and blood pressure, they now recommend we get to bed a little earlier, bringing the tally to Life’s Essential Eight (35 Across).
TCTMD checked in with Eugene Yang, MD (University of Washington, Bellevue), chair of the American College of Cardiology’s Prevention of Cardiovascular Disease Council, to see what might have slipped through the cracks of our 2022 Crossword.
For Yang, the CHAP trial was one of the most meaningful of the year, noting that maternal mortality associated with pregnancy in the US is the highest among industrialized countries. One of the possible drivers of this high mortality is that physicians may not have been aggressively treating high blood pressure, Yang suggested. On the basis of CHAP, the American College of Obstetricians and Gynecologists now recommends using 140/90 mm Hg as the threshold for starting or uptitrating medical therapy for chronic hypertension in pregnancy, whereas the previous threshold was 160/110 mm Hg.
From the European Society of Cardiology 2022 Congress, Yang highlighted new data from the Cholesterol Treatment Trialists’ (CTT) Collaboration as one of the year’s big studies. That analysis showed statins were associated with only a small increased risk of muscle pain or weakness in the first year and that the vast majority of muscle symptoms were not due to treatment. The CTT results, which are supported by data from nocebo studies, such as SAMSON, are necessary to counteract widespread misinformation around statins.
“We know they’re one of the most important and inexpensive treatments to lower cardiovascular risk,” he said. “We need to change the perception that these medications are dangerous and carry a large amount of side effects when they do not. Hopefully, this [CTT analysis] redirects the conversation.”
Finally, Yang pointed to the Diuretic Comparison Project (DCP), a study of Veterans Affairs patients presented at the AHA meeting and simultaneously published in the New England Journal of Medicine, as one of the year’s most impactful. In this large trial of thiazide diuretics, patients treated with hydrochlorothiazide (HCTZ) had a similar occurrence of major adverse cardiovascular events as those treated with chlorthalidone. Prior to DCP, the choice of thiazide had been controversial. Although most physicians use HCTZ because it’s associated with fewer side effects, landmark hypertension studies, such as ALLHAT and SHEP, used chlorthalidone as the thiazide.
“This allows us to feel more comfortable, at least from this study, that there’s no clear advantage of chlorthalidone versus hydrochlorothiazide,” said Yang.