With the end of the year rapidly approaching, the American Heart Association (AHA) editorial staff has published a list of some of 2023s biggest breakthroughs in cardiovascular disease (CVD) research.

In 2023, investigators made important strides toward improving and extending the lives of people affected by these conditions, along with potentially lowering the burden of disease with therapies and strategies that hold promise for prevention, the AHA editors wrote. Particularly noteworthy were advances in technology to restore blood flow to blocked and narrowed arteries, potentially preventing death and disability for a wide range of patients, including those with severe illness.

The AHAs choices included:

A new investigational drug, zilebesiran, can decrease the production of angiotensinogen, a protein believed to contribute to a patient's risk of high blood pressure. Early data suggests taking zilebesiran for eight weeks is associated with reductions in key blood pressure measurements compared to a placebo; higher doses are linked to higher reductions.

Not only does the suppression of angiotensinogen hold promise for more effectively reducing hypertension for extended periods of time after injection, there is growing excitement over the possibility it also might be therapeutic for kidney and heart disease, AHAs editors wrote. The results are also highly significant because only a single dose was needed, which could improve access to care and adherence to long-term drug regimens.

The full analysis was published in The New England Journal of Medicine.[1]

The concept of using intravascular imaging to guide percutaneous coronary intervention (PCI) procedures gained significant momentum in 2023. (Cardiovascular Business wrote about this topic several times, including here, here and here.)

AHAs editors highlighted multiple studies that examined the potential impact of intravascular imaging. The ILUMIEN IV study, for example, found that PCI guided by optical coherence tomography (OCT) resulted in a larger minimum stent area than angiography-guided PCI. That analysis was published in full in The New England Journal of Medicine.[2]

The OCTIVUS trial, published in Circulation, showed that OCT-guided PCI and intravascular ultrasound were both safe and effective treatment options for patients with significant coronary artery lesions.[3]

Treating atrial fibrillation (AFib) patients with direct-acting oral anticoagulants (DOACs) after a stroke can reduce their risk of experiencing another strokebut the exact timing of prescribing those DOACs remains unclear.

Doing so too early could increase the risk of brain bleeds, while doing so later could raise the risk of having a second stroke, AHAs editors wrote.

Physicians typically recommend stroke patients wait a few days before they start taking DOACs, but new research published in The New England Journal of Medicine provided evidence that those patients could start treatment even sooner.[4]

Overall, the study found that starting DOAC treatment within 48 hours of a stroke was associated with outcomes comparable to starting treatment on day three or four after a strokeone key difference was that the risk of recurrent stroke appeared to decrease with early treatment.

The trial was not designed to test whether earlier treatment was better than later treatment, but to help health care providers estimate possible outcomes, the editors wrote.

Original post:

New drugs, updated treatment strategies: 5 important trends in cardiology from an eventful 2023 - Cardiovascular Business