Key Developments in Prevention and Cardiometabolic Health in 2024

Advances in Lipoprotein(a)-Lowering Therapies

• Two-phase II trials highlighted promising advancements in lowering lipoprotein(a) (Lp(a)), a cardiovascular risk factor primarily influenced by genetics.
• The KRAKEN trial tested the oral agent muvalaplin (Eli Lilly), while the ALPACAR-360 trial evaluated the siRNA therapy zerlasiran (Silence Therapeutics). Both therapies showed significant potential for reducing Lp(a) levels, marking progress in tackling a previously challenging target.

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Breakthroughs with GLP-1 and GIP Agonists

• The FLOW Trial confirmed that semaglutide (Ozempic/Wegovy; Novo Nordisk) reduces major kidney disease events in patients with type 2 diabetes and chronic kidney disease, along with benefits like weight loss, improved heart failure symptoms, and reduced cardiovascular events.
• The SUMMIT trial demonstrated that tirzepatide (Zepbound/Mounjaro; Eli Lilly) reduced cardiovascular mortality and heart failure events by nearly 40% in patients with obesity-related HFpEF, with additional benefits such as reduced epicardial fat and inflammation.
• Despite their efficacy, the high costs of GLP-1 receptor agonists remain a barrier, with future development of oral formulations offering hope for broader access.

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Controversy Over Sugar Alcohols

• New evidence linked sugar alcohols, such as xylitol, to higher cardiovascular risk, raising concerns about their safety as low-calorie sweeteners in heart-healthy diets.
• This finding challenges their perception as a benign alternative to sugar and underscores the need for further research into their long-term effects.

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Digital Tools for Statin Therapy

• The TACTiC trial demonstrated the effectiveness of a digital app in enabling patients to self-identify for over-the-counter statin therapy.
• This tool addresses stigma associated with statin use, encouraging more widespread adoption of this essential cardiovascular prevention strategy.

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Emerging Blood Pressure Therapies

• The KARDIA-2 trial revealed that zilebesiran (Alnylam Pharmaceuticals), a twice-yearly injectable siRNA targeting angiotensinogen, significantly lowers systolic blood pressure when added to standard therapies.
• Additionally, the BPROAD trial supported intensive blood pressure management, with targets below 120 mm Hg in patients with type 2 diabetes, offering new perspectives on optimal treatment strategies.

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European Guidelines on Hypertension

• Updated European Society of Cardiology (ESC) guidelines for hypertension aligned with 2017 US recommendations, lowering blood pressure targets to improve cardiovascular outcomes.
• The PREVENT tool continued to prove its accuracy in predicting risks of MI, stroke, and heart failure, offering insights into long-term cardiovascular, kidney, and metabolic risks for individuals as young as 30 years old.

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Food as Medicine and Population Health

• The concept of "food is medicine" gained prominence as a simple, cost-effective strategy for cardiovascular disease prevention.
• Experts emphasized that combining advanced therapies like GLP-1 agonists with lifestyle interventions is crucial for achieving sustainable health outcomes on a population level.

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New LDL-Lowering Drugs

• The BROOKLYN trial showed that the investigational CETP inhibitor obicetrapib (NewAmsterdam Pharma) significantly reduces LDL cholesterol in patients with heterozygous familial hypercholesterolemia.
• This promising development highlights a potential new approach to managing high cholesterol in patients with genetic predispositions.

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Plastic Pollution and Cardiovascular Risk

• A study identified microscopic plastic particles in the atherosclerotic plaque of patients with carotid stenosis, linking these particles to an increased risk of adverse cardiovascular events.
• This research raises awareness of plastic pollution as a potential contributor to cardiovascular disease and a target for prevention.

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Preoperative Food Intake and Cath Lab Practices

• New findings confirmed that allowing patients to eat before cardiac catheterization is safe and may offer benefits compared to traditional fasting protocols.
• This challenges the long-standing "nothing by mouth after midnight" practice and aligns with efforts to improve patient comfort and outcomes.

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Conclusion

2024 brought significant advancements in both cutting-edge therapies and fundamental prevention strategies, paving the way for improved cardiovascular health outcomes. From novel drugs targeting specific risk factors to rethinking dietary and procedural norms, this year underscored the importance of integrating innovation with tried-and-true prevention techniques.