AHA 2020 topics: Systemic racism, novel research, COVID-19 discussion with Fauci
Trials of novel medications and conversations on systemic racism and the ongoing COVID-19 pandemic are set to be featured at the virtual American Heart Association Scientific Sessions, which start Friday.
The conference, which will run until Tuesday, will feature a talk by Anthony S. Fauci, MD, director of the National Institute of Allergy and Infectious Diseases, on the CV implications of the ongoing global pandemic.
One late-breaker to be presented is the phase 3 GALACTIC-HF trial. This study evaluated the effect of omecamtiv mecarbil (Amgen/Cytokinetics) in patients with HF with reduced ejection fraction.
According to Donald M. Lloyd-Jones, MD, ScM, senior associate dean for clinical and translational research, chair of the department of preventive medicine, director of Northwestern University Clinical and Translational Sciences Institute, the Eileen M. Foell Professor of Preventive Medicine (Epidemiology) and professor of medicine (cardiology) and of pediatrics at Northwestern University Feinberg School of Medicine and chair of the AHA Committee on Scientific Sessions Programming, omecamtiv mecarbil is a selective cardiac myosin activator that helps the heart pump stronger and more frequently by enhancing cardiac contractility.
“It’s the first time we’ve seen an outcomes trial with this drug, and it’s being used in patients who have chronic heart failure with reduced ejection fraction who are hospitalized,” Lloyd-Jones said during a press conference. “The top-line results have been reported in a press release. They reported a statistically significant, but modest reduction in heart failure hospitalization and cardiovascular death and also reported a little more on the secondary endpoints. We need to keep our eye on this trial; there is more than meets the eye from the top-line results, and it will be interesting to see exactly what the outcomes are related to this drug.”
Also being presented are the results from the AFFIRM-AHF trial, which evaluated the use of iron supplementation in patients who present with HFrEF and are also iron-deficient at the time of hospitalization.
“There seem to be few downsides and risks, and some think it helps the heart work better and improve outcomes in these heart failure patients,” Lloyd-Jones said during the press conference. “But that is an unproven strategy as yet, and this is the first large-scale trial that will assess this strategy in a large number of patients with a full outcomes assessment.”
The VITAL Rhythm trial, a follow-up to the VITAL trial presented at the 2019 AHA Scientific Sessions, analyzed the impact of vitamin D, low-dose fish oil or both on initial atrial fibrillation events.
As Healio previously reported, interventions with vitamin D or omega-3 did not reduce rates of first HF hospitalization among healthy adults, but researchers noted a benefit in recurrent HF hospitalization in those on fish oil supplementation.
More research into polypill use will also be presented in the results of the TIPS and the TIPS+ASA trials.
The first trial will evaluate a polypill compared with placebo for CV outcomes. The polypill contains four drugs: a thiazide diuretic, a beta-blocker, an ACE inhibitor and a statin.
The TIPS+ASA trial will utilize the same strategy but compare the polypill with or without the addition of aspirin for CV outcomes reduction.
The HARP-MINOCA trial was conducted with the goal of evaluating the underlying causes of MI with nonobstructive coronary arteries (MINOCA) among women, who are disproportionately affected by this disease.
“For the first time, investigators systematically took women with this problem and [conducted] a deeper dive and took a very close look at their coronary arteries with [OCT] to look at the contours of the artery, not just by injecting dye, but doing direct visualization and ultrasound of those coronary arteries,” Lloyd-Jones said during the press conference. “They also did cardiac MRIs on all these patients to understand whether there’s inflammation in the muscle or other things that would explain the presentation of heart attack. This will be the first and best look at this vexing clinical problem that particularly affects women, and it promises to be important in guiding our approach to these women.”
Another trial to be presented is the THALES study, which evaluated the addition of ticagrelor (Brilinta, AstraZeneca) to aspirin for the prevention of stroke or transient ischemic attack of atherosclerotic origin.
“Ticagrelor is a stronger antiplatelet agent compared to clopidogrel,” Manesh Patel, MD, professor of medicine, chief of the division of clinical pharmacology and the division of cardiology at Duke University School of Medicine and member of the Duke Clinical Research Institute, said during the press conference. “In studies where we studied ticagrelor against clopidogrel in acute coronary syndromes, peripheral disease and other spaces, we [observed] signals that more antiplatelet therapy might be helpful in patients with acute ischemic stroke. There was a large outcome trial called SOCRATES, but that didn’t demonstrate exactly the risk-benefit ratio that one might imagine, and some of this was [related to the question of] whether we were getting the right patients into the study.”
Addressing systemic racism
In addition to late-breaking science, this year’s virtual AHA Scientific Sessions will also address ways to overcome systemic racism and feature talks on the use of behavioral interventions for the advancement of equity. The schedule will feature oral abstracts on racial/ethnic disparities in cardiometabolic care and evidence-based strategies to reduce inequities in CV care.
In addition, the schedule includes keynote speeches from David Williams, MPH, PhD, Florence Sprague Norman and Laura Smart Norman Professor of Public Health and chair of the department of social and behavioral sciences at the Harvard T.H. Chan School of Public Health, and Lisa A. Cooper, MD, Bloomberg Distinguished Professor, general internist, social epidemiologist and health services researcher at the Johns Hopkins Bloomberg School of Public Health.
“As a thread through the scientific session meetings, we will have a number of different sessions directly addressing structural racism as a public health crisis,” Lloyd-Jones said during the press conference. “We’ll have two keynote addresses ... followed by a robust discussion from a panel of experts from government, public health, industry, education, training venues and health care. This will start to change the conversation from just identifying the gaps and the disparities that are caused by structural racism and moving toward solutions.”
‘AHA Goes Viral’
During the virtual event “AHA Goes Viral,” James A. de Lemos, MD, professor of medicine and the Sweetheart Ball-Kern Wildenthal, MD, PhD, Distinguished Chair in Cardiology at UT Southwestern Medical Center, will present findings from a rapidly built data registry for the evaluation of the effects of COVID-19 across many hospital systems.
During this discussion, de Lemos will present data from more than 15,000 patients with COVID-19, including morbidity and mortality data, the rates of major adverse CV events and overall CV outcomes.
Before this presentation, Fauci will discuss the ongoing global pandemic.
“Dr. Fauci will be joining us ... in a slightly different session focused on the latest insights of COVID-19 and cardiovascular disease,” Lloyd-Jones said during the presentation. “Dr. Fauci is going to provide an important overview of the pandemic curve, its impact on the population and perhaps how we can avoid this ongoing self-inflicted wound as we see the cases rise sharply, now during our third wave.”