Tuesday, March 7, 2023

Hello Health Rounds Readers! The biggest weekend of the year for heart doctors wrapped up on Monday in New Orleans, where nearly 13,000 clinicians heard about advances in their field at the annual meeting of the American College of Cardiology and the World Congress of Cardiology. Today we've highlighted just a fraction of the presentations; use the hashtags #ACC23 and #WCCardio on Twitter to see more of what attendees found exciting.

In breaking news, see these stories from our Reuters journalists: California will not do business with Walgreens after the company said it would not dispense abortion pills in some states; Weight Watchers enters the obesity drug business; Biden plans tax on high-earners in bid to save Medicare.

New Orleans was the site this past weekend for a large meeting of cardiology specialists. Below are some highlights of the research presented at the meeting. REUTERS/Kathleen Flynn.

Study Rounds

A drug for people who cannot tolerate statins

For patients who cannot tolerate widely-used cholesterol-lowering statins, bempedoic acid could be a useful substitute, after a clinical trial demonstrated it significantly lowered heart attack risk.

The nearly 14,000 participants had previously stopped taking statins because of adverse effects on muscles and other tissues. Unlike statins, bempedoic acid works in the liver, so it has fewer such effects.

Six months into the trial, the reduction in "bad" LDL cholesterol was 29.2 milligrams-per-deciliter greater in patients taking bempedoic acid than in those who received a placebo, researchers reported at the meeting on Saturday and in The New England Journal of Medicine (NEJM).

During an average of 40 months of treatment, bempedoic acid, sold by Esperion Therapeutics as Nexletol, led to a 23% reduction in risk of a fatal or nonfatal heart attack and 29% lower risk in the need for artery-clearing procedures versus a placebo.

However, bempedoic acid did not reduce patients' risks for fatal or nonfatal stroke, death from cardiovascular causes, or death from any cause, and it increased the risk for gout and gallstones. Bempedoic acid has also been associated with a higher risk for tendon rupture.

The 20%-25% reduction in LDL cholesterol reported for bempedoic acid is less than the 40%-50% reductions typically achieved with statins, according to a statement issued by the Cleveland Clinic, where the Esperion-funded study was based.

Dr. John Alexander of Duke Health in Durham, North Carolina, in an NEJM editorial said the data should increase the use of bempedoic acid in patients unable or unwilling to take statins.

But "given the overwhelming evidence of the vascular benefits of statins," he said, "clinicians should continue their efforts to prescribe them at the maximum tolerated doses for appropriate patients, including those who may have discontinued statins (in the past)."

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Cancer-drug heart damage reduced by statins

The risk of progressing towards heart failure due to treatment with anthracycline chemotherapy might be lessened by the cholesterol-lowering drug atorvastatin, widely known by the brand name Lipitor, researchers reported on Saturday.

Anthracyclines - strong drugs used for many types of cancer - significantly increase patients' risks for heart failure.

At U.S. and Canadian hospitals, 300 adults receiving anthracycline drugs for lymphoma were randomly assigned to take a daily atorvastatin pill or a placebo for one year.

The proportion of patients who experienced at least a 10% decline in the heart's pumping ability, bringing them to the brink of heart failure, was 9% with atorvastatin versus 22% with placebo. After accounting for other risk factors, the odds of that outcome were three-fold higher in the placebo group, researchers said.

Overall at one year, the difference between groups in heart-pumping ability was small, researchers found. But among patients with weak hearts to start, 13% taking atorvastatin reached the brink of heart failure, versus 29% taking placebo.

The study funded by the U.S. National Institutes of Health did not assess how many patients progressed to heart failure, a condition in which the heart becomes too weak to pump blood efficiently.

"Patients with lymphoma who are treated with anthracyclines and are at high risk of cardiac dysfunction and heart failure would benefit from statin therapy," study co-leader Dr. Marielle Scherrer-Crosbie of the Hospital of the University of Pennsylvania in Philadelphia, said in a statement.

A recent study of breast cancer patients found statins did not reduce anthracycline-related heart damage, but Scherrer-Crosbie's team believes statins might be more helpful in lymphoma patients because their anthracycline doses are higher.

Wearables tested for detecting heart attacks, heart failure

Two studies presented on Monday suggest heart attacks can be diagnosed in five minutes in patients wearing an experimental device on the wrist, and heart failure patients are less likely to be rehospitalized if they wear a stick-on sensor that alerts doctors to fluid-buildup in the lungs.

The wrist-worn device for detecting heart attacks, being developed by RCE Technologies Inc, uses infrared light to detect the presence in the blood of a protein called troponin-I that indicates heart damage. The device sends signals via Bluetooth to a cloud-based system, where a machine learning algorithm predicts the wearer's troponin level.

Researchers in India tested the sensor in 239 patients with symptoms suggesting a heart attack. Patients also underwent blood tests for troponin-I, electrocardiography to assess the heart's electrical signals, and echocardiography or angiography to image the heart's blood flow.

The wrist sensor was nearly 90% accurate at predicting elevated troponin-I levels, researchers reported at the meeting and in the European Heart Journal - Digital Health.

Patients with abnormal troponin levels detected by the device were about four times more likely to have an obstructed coronary artery than people with negative device results.

"If you use this device and it comes out positive, you're fairly sure this patient can be admitted for fast tracking diagnostic tests, treatment and intervention," study leader Dr. Partho Sengupta of Rutgers Robert Wood Johnson Medical School in New Brunswick, New Jersey said in a statement.

Eventually, he said, the device could help prioritize patients needing urgent care.

In a separate study of 502 hospitalized heart failure patients in the U.S. and Europe, researchers tested a device being developed by study sponsor Zoll Medical Corp that gets attached to the left side of the chest with an adhesive patch and uses radiofrequency signals to estimate fluid levels around the lungs.

Everyone wore the device for 90 days, but at only half the hospitals were the devices turned on to transmit data to patients' doctors.

When doctors monitored lung fluid using the system, patients were 38% less likely to be rehospitalized for heart failure and 38% less likely to experience either a heart failure-related emergency department visit, hospitalization or death, compared with patients whose monitors were turned off.

This newsletter was edited by Bill Berkrot.

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