AHA Selects 2023’s Leading Cardiovascular Research

The American Heart Association (AHA) has released its list of the most important developments in CVD research for 2023, which runs the gamut from major trials of interventions and medical therapies to cohort studies providing insights into health inequities, the impact of healthy eating, and more.

The AHA has been doing this since 1996, according to a press release.

“Every year, we compile an overview of scientific research that advances our understanding of how to prevent, treat, and manage heart disease and stroke,” Mariell Jessup, MD, AHA’s chief science and medical officer, said in the release. “Whether the science points to new ways to treat long-known health conditions, disparities in care, or how to prevent some of our most pressing problems, such as high blood pressure, diabetes or obesity, the findings help people, healthcare professionals, policymakers, and others make better informed healthcare decisions.”

On this year’s list are multiple areas in which major randomized trials have provided impactful results. That includes two trials showing clinical benefits from using the glucagon-like peptide-1 (GLP-1) receptor agonist semaglutide (Wegovy; Novo Nordisk)—initially developed as a treatment for type 2 diabetes—in high-risk patients with heart disease: STEP-HFpEF in patients with heart failure with preserved ejection fraction and SELECT in patients with overweight or obesity and preexisting CVD, but no diabetes.

“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 AHA states.

Other consequential trials released in 2023, according to the AHA’s compilation, included:

• BASIL-2 and BEST-CLI, which provided conflicting conclusions about the optimal strategy for treating PAD patients with chronic limb-threatening ischemia.
• ANGEL-ASPECT, SELECT2, and a third trial that demonstrated improved outcomes when endovascular thrombectomy was used in patients with large-core ischemic strokes, affirming the benefits observed in last year’s RESCUE-Japan LIMIT trial.
• Several trials evaluating use of IVUS and optical coherence tomography (OCT) to guide PCI in complex patients, including ILUMIEN IV, OCTOBER, OCTIVUS, and RENOVATE-COMPLEX-PCI, which, taken together, “illustrate the complexity of coronary artery disease and the promise of more-advanced guidance technologies for tailoring treatment to improve patient outcomes,” the AHA says.
• ELAN, which suggested that direct oral anticoagulants can be started soon after an ischemic stroke in patients with atrial fibrillation rather than waiting for several days, as recommended in guidelines.

Another development highlighted by the AHA was a phase I study of zilebesiran, a novel injectable RNA-interference agent that inhibits the production of angiotensinogen in the liver with the aim of reducing blood pressure; patients with hypertension saw reductions in both angiotensinogen and BP. Later in the year, the phase II KARDIA-1 study showed that treatment reduced ambulatory systolic BP through 6 months in patients who weren’t on any other antihypertensive drugs.

The AHA also put a spotlight on evidence linking obesity, chronic kidney disease, diabetes, and CVD and on a new condition called cardiovascular-kidney-metabolic (CKM) syndrome. This was the subject of a scientific statement and a presidential advisory released by the association in October and has been incorporated into the PREVENT equations, which physicians can use to estimate 10- and 30-year risks of MI, stroke, and heart failure.

Rounding out this year’s list of top research news are cohort studies demonstrating a link between adherence to healthy dietary patterns recommended in the Dietary Guidelines for Americans and lower mortality risks across racial/ethnic groups and underscoring the impact of social determinants of health on disparities in CVD.

To the latter point, the AHA pointed to a study in the Journal of the American Heart Association showing that even though CVD mortality declined overall in the US from 2009 to 2018, rural counties and those with higher proportions of Black residents continued to have higher mortality levels. And in a study published in the New England Journal of Medicine, Black and Hispanic individuals who suffered a witnessed cardiac arrest were less likely than their white counterparts to receive bystander CPR, irrespective of the racial/ethnic makeup or income level of the neighborhood in which the event occurred.

“As noted in a related editorial,” the AHA says, “efforts to improve bystander CPR rates may be complicated ‘by a legacy of structural racism that has left many of our communities segregated and with inequitable social determinants of sudden cardiac death.’”