Highlights From ACC.22

In this video, Michael J. Bloch, MD, highlights key takeaways from The American College of Cardiology 2022 conference in Washington, DC, including:

• sessions on inflammation, lipoprotein(a), and investigational therapeutics that target those risk factors
• results from the CANTOS and APOLLO Trials and study design of the ZEUS trial
• 3-year follow-up data from the SPYRAL HTN-ON MED Study; and
• new studies on coffee consumption and cardiovascular risk. 

Additional Resource:

• ACC.22. April 2-4, 2022. Washington, DC. Accessed May 2, 2022. https://accscientificsession.acc.org/

Michael J. Bloch, MD, is an associate professor at the University of Nevada School of Medicine, the medical director of vascular care at the Renown Institute for Heart and Vascular Health, and the President of Blue Spruce Medical Consultants, PLLC in Reno, Nevada.

TRANSCRIPTION:

Dr Michael Bloch: Hello, my name's Dr. Michael Bloch. I'm a vascular medicine provider, and physician in Reno, Nevada, and I wanted to share with you what caught my eye recently at the ACC Scientific Sessions that were recently held in Washington DC. First of all, I wanted to talk a little bit about the increased attention that we saw about two well-known but is yet untargeted residual risk factors for recurrent ASCBD events. Those were inflammation and elevated lipoprotein A. For the first time, we may be entering an era where we actually have therapeutics that directly target those risk factors. In terms of inflammation, at ACC, we were presented with an important subgroup analysis from the Cantos Trial. In Cantos, the use of a relatively non-specific blocker of inflammation, it was a blocker of IL-1, led to a reduction in cardiovascular events, but at the cost of an increase in intolerable adverse events.

What we saw actually presented at ACC was subgroup analysis from Cantos, in patients with chronic kidney disease, who seem to have particular net clinical benefit in that clinical trial. As such, there's been a new trial that's been designed, it's called the Zeus trial, that is looking at a more specific IL-6 blocker, a more specific blocker down the inflammation pathway. It's being designed to test this IL-6 blocker versus placebo in patients with known atherosclerotic cardiovascular disease, CKD and elevated CRP. In terms of elevated lipoprotein A, this is another emerging risk factor that we recognize increases residual risk in patients who've had atherosclerotic cardiovascular events, but we've never had drugs available to us that blocked or lowered this agent. We now at ACC saw data from the Apollo study, where we were presented with what I believe is data from the third investigational small interfering RNA that blocks the synthesis of lipoprotein A in the liver.

These small interfering RNAs are very effective, at least at lowering LPL-A. They have been shown to have a tolerable side effect profile. This particular drug did seem to add a high dose lower lipoprotein A more than the other drugs that we've had presented to us. Although, obviously this was not head-to-head data, but we are eagerly awaiting the ongoing and implant endpoint studies with these agents to give us potentially another arrow in our quiver in patients who have residual risk due to elevated lipoprotein A. Moving to the field of hypertension, we are presented with three-year follow-up data from the Spyral on med pilot study. This was a relatively small study of radiofrequency ablation of the renal vein. I'm sorry, of the sympathetic nerves that run along the renal arteries. This study was actually as a pilot was presented some time ago in terms of its primary endpoint, but we now saw three-year follow-up data from this pilot study.

Importantly, even after medications were added back for these patients, three years after renal denervation, these patients still had a significant reduction in office blood pressure. We're really seeing a lot of consistent data coming out with renal denervation, both with radiofrequency ablation as well as with ultrasound ablation of the nerves. There are a lot more studies that are going to become available in short order, including the follow-up from the entire Spyral on med study, which we hope to have available to us soon, as well as a study called Radiance 2, which uses an ultrasound-based catheter.

Finally, there were a couple of studies presented around coffee consumption and cardiovascular risk. These studies provided important info to inform my patients, but also I think it was important as a particular coffee enthusiast. It was important for me personally. In these studies, they were observational studies. Investigators used data sets from the observational UK biobank that included health information on over a half million people who were followed for at least 10 years.

Not only did the researchers find no evidence of increased cardiovascular events with excessive coffee consumption. They also found that patients who drank two to three cups a day had the lowest risk of cardiovascular events, including coronary artery disease, arrhythmia, and cardiovascular death. Those who drank two to three cups actually had better disease-free survival than those who drank no coffee at all. Those are the studies and issues that really caught my eye at ACC. Please go enjoy a cup of your favorite beverage and be sure to check back with this channel often for new information. Thank you very much for your attention.